Provider Demographics
NPI:1295353290
Name:ALLEN, ASHLEY SMITH (NP-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SMITH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 STAYSAIL CV
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7042
Mailing Address - Country:US
Mailing Address - Phone:601-540-8316
Mailing Address - Fax:
Practice Address - Street 1:RANKIN RURAL MEDICAL CENTER
Practice Address - Street 2:129 CENTER STREET SUITE B
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218
Practice Address - Country:US
Practice Address - Phone:769-233-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903972363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care