Individual
ASHLEY BLALOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4903 BRUCEVILLE SLAB RD, FRIENDSHIP, TN 38034-4325
(731) 676-0393
Mailing address
2373 AUGUSTA ST, DYERSBURG, TN 38024-8942
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
21250
TN
363LP2300X
Primary Care Nurse Practitioner
Primary
21250
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679931414
—
TN
Enumeration date
02/08/2016
Last updated
04/15/2022
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