Provider Demographics
NPI:1912294562
Name:WOOTEN, ASHLEY ROSSER (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ROSSER
Last Name:WOOTEN
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 1:86 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3052
Mailing Address - Country:US
Mailing Address - Phone:864-334-8979
Mailing Address - Fax:833-794-1844
Practice Address - Street 1:86 VILLA RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3052
Practice Address - Country:US
Practice Address - Phone:864-334-8979
Practice Address - Fax:833-794-1844
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAPPROVEDMedicaid
SCNP2232Medicaid