Provider Demographics
NPI:1518235142
Name:BURROUGHS LOVETT, ASHLEY NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:BURROUGHS LOVETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 DIVISION ST
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-2906
Mailing Address - Country:US
Mailing Address - Phone:228-388-2599
Mailing Address - Fax:228-388-9861
Practice Address - Street 1:1025 DIVISION ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-2906
Practice Address - Country:US
Practice Address - Phone:228-388-2599
Practice Address - Fax:228-388-9861
Is Sole Proprietor?:No
Enumeration Date:2011-12-10
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR889915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS311626YUPLMedicare PIN