Ashley Blalock, | |
4903 Bruceville Slab Rd, Friendship, TN 38034-4325 | |
(731) 676-0393 | |
Not Available |
Full Name | Ashley Blalock |
---|---|
Gender | Female |
Speciality | Nurse Practitioner - Primary Care |
Location | 4903 Bruceville Slab Rd, Friendship, Tennessee |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1679931414 | NPI | - | NPPES |
1679931414 | Medicaid | TN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LF0000X | Nurse Practitioner - Family | 21250 (Tennessee) | Secondary |
363LP2300X | Nurse Practitioner - Primary Care | 21250 (Tennessee) | Primary |
Entity Name | Southeastern Physician Services Pc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1083835441 PECOS PAC ID: 0042307852 Enrollment ID: O20071025000571 |
Entity Name | Lifetime Fat Loss Centers Of Knoxville Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1093265605 PECOS PAC ID: 2567742430 Enrollment ID: O20161212000345 |
Entity Name | Lauderdale Community Hospital Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1962034272 PECOS PAC ID: 9830505023 Enrollment ID: O20210422000338 |
Mailing Address | Practice Location Address |
---|---|
Ashley Blalock, 2373 Augusta St, Dyersburg, TN 38024-8942 Ph: () - | Ashley Blalock, 4903 Bruceville Slab Rd, Friendship, TN 38034-4325 Ph: (731) 676-0393 |
Phyllis P Moore, DNP,FNP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 600 Main St, Friendship, TN 38034 Phone: 731-677-3400 Fax: 731-677-3402 | |
Madelyne Ellis, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1159 Walter Taylor Rd, Friendship, TN 38034 Phone: 931-787-4062 |