Provider Demographics
NPI:1972907327
Name:TANT, ASHLEY (ARNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:TANT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4402 CHURCHMAN AVE
Mailing Address - Street 2:STE 409
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1190
Mailing Address - Country:US
Mailing Address - Phone:502-368-9561
Mailing Address - Fax:502-882-1263
Practice Address - Street 1:4402 CHURCHMAN AVE
Practice Address - Street 2:STE 409
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1190
Practice Address - Country:US
Practice Address - Phone:502-368-9561
Practice Address - Fax:502-882-1263
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008801363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100407370Medicaid
INM162787002Medicare PIN
KYK126000Medicare PIN