Basic Information
| Provider Information | |||||||||
| NPI: | 1366798951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASHBURN | ||||||||
| FirstName: | PAMELA | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 254 REN MAR DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | PLEASANT VIEW | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371463723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312452086 | ||||||||
| FaxNumber: | 9312452087 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 N WILLOW AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385012335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315288899 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2012 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 16907 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1530362 | 05 | TN | MEDICAID |