Provider Demographics
NPI:1477352904
Name:BULLOCK, ASHLEIGH NICHOLE (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:NICHOLE
Last Name:BULLOCK
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-1502
Mailing Address - Country:US
Mailing Address - Phone:731-415-6313
Mailing Address - Fax:
Practice Address - Street 1:238 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-1502
Practice Address - Country:US
Practice Address - Phone:731-415-6313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant