Provider Demographics
NPI:1255782025
Name:PHELPS, ASHLEY (FNP-BC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 E COLLEGE ST
Mailing Address - Street 2:STE 1
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4563
Mailing Address - Country:US
Mailing Address - Phone:931-207-8630
Mailing Address - Fax:931-207-8629
Practice Address - Street 1:1119 E COLLEGE ST
Practice Address - Street 2:STE 1
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4563
Practice Address - Country:US
Practice Address - Phone:931-207-8630
Practice Address - Fax:931-207-8629
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2015010039OtherANCC
TN21157OtherFNP