Provider Demographics
NPI:1487990859
Name:SELF, ASHLEY NICHOLE (NP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:SELF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-243-8153
Mailing Address - Fax:
Practice Address - Street 1:1819 W CLINCH AVE STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916
Practice Address - Country:US
Practice Address - Phone:865-524-5365
Practice Address - Fax:865-673-8007
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530802Medicaid
TN0677340003Medicare NSC
TN0677340008Medicare NSC
TN0677340007Medicare NSC
103I509864Medicare PIN
TN0677340009Medicare NSC
TN0677340002Medicare NSC
TN0677340004Medicare NSC
TN0677340010Medicare NSC
TN0677340005Medicare NSC
TN103I509869Medicare PIN
TN1530802Medicaid