Provider Demographics
NPI:1710617485
Name:ENGEL, ASHLEY (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ENGEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:REVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3553 OLD WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-5425
Mailing Address - Country:US
Mailing Address - Phone:423-883-2479
Mailing Address - Fax:
Practice Address - Street 1:9400 RHEA COUNTY HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-7922
Practice Address - Country:US
Practice Address - Phone:423-775-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31103363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner