Provider Demographics
NPI:1932798428
Name:LETSON, ASHLEY TICE (CRNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TICE
Last Name:LETSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 COUNTY ROAD 251
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-8570
Mailing Address - Country:US
Mailing Address - Phone:256-410-6547
Mailing Address - Fax:
Practice Address - Street 1:707 W MARKET ST STE C
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2463
Practice Address - Country:US
Practice Address - Phone:256-444-1815
Practice Address - Fax:256-444-0385
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-147215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily