Provider Demographics
NPI:1790025302
Name:REAGAN, ASHLEY RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RENEE
Last Name:REAGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RENEE
Other - Last Name:DODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 BROWN AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-7739
Mailing Address - Country:US
Mailing Address - Phone:931-484-8861
Mailing Address - Fax:931-456-1319
Practice Address - Street 1:118 BROWN AVE
Practice Address - Street 2:STE 103
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-7739
Practice Address - Country:US
Practice Address - Phone:931-484-8861
Practice Address - Fax:931-456-1319
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2303363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ016084Medicaid
TN20297I2684Medicare PIN