Provider Demographics
NPI:1356781900
Name:WILSON, ASHLEY N (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:N
Last Name:WILSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:ASHLEY
Other - Middle Name:N
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:200 NETTLETON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-8260
Mailing Address - Country:US
Mailing Address - Phone:423-419-5550
Mailing Address - Fax:833-944-2041
Practice Address - Street 1:200 NETTLETON RD STE 1
Practice Address - Street 2:
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752-8260
Practice Address - Country:US
Practice Address - Phone:423-419-5550
Practice Address - Fax:833-944-2041
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008078363LF0000X
VA0024172166363LF0000X
TN25867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily