Provider Demographics
NPI:1730670704
Name:CARLISLE, ASHLEY RENEE' (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RENEE'
Last Name:CARLISLE
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 1:10751 BENT BROOK DR
Mailing Address - Street 2:
Mailing Address - City:VANCE
Mailing Address - State:AL
Mailing Address - Zip Code:35490-2589
Mailing Address - Country:US
Mailing Address - Phone:601-616-0473
Mailing Address - Fax:
Practice Address - Street 1:1001 MIMOSA PARK RD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-4843
Practice Address - Country:US
Practice Address - Phone:205-752-5857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-135050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner