Provider Demographics
NPI:1992070452
Name:MYATT, ASHLEY E (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:E
Last Name:MYATT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5653 FRIST BLVD
Mailing Address - Street 2:SUITE 731
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2062
Mailing Address - Country:US
Mailing Address - Phone:615-885-2778
Mailing Address - Fax:615-986-6052
Practice Address - Street 1:5653 FRIST BLVD
Practice Address - Street 2:SUITE 731
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2062
Practice Address - Country:US
Practice Address - Phone:615-885-2778
Practice Address - Fax:615-986-6052
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2123363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant