Provider Demographics
NPI:1821049545
Name:YLITALO, ASHLEY D (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:D
Last Name:YLITALO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52268
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2268
Mailing Address - Country:US
Mailing Address - Phone:865-584-2146
Mailing Address - Fax:865-584-9660
Practice Address - Street 1:1300 OLD WEISGARBER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1291
Practice Address - Country:US
Practice Address - Phone:865-584-2146
Practice Address - Fax:865-584-9660
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3334605Medicaid
TN3334605Medicare ID - Type Unspecified
TN3334605Medicaid