Provider Demographics
NPI:1992553531
Name:WATERS, ASHLEY TAYLOR COLEMAN (NP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TAYLOR COLEMAN
Last Name:WATERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 ARMORY DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-2419
Mailing Address - Country:US
Mailing Address - Phone:757-659-9903
Mailing Address - Fax:
Practice Address - Street 1:1337 ARMORY DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-2419
Practice Address - Country:US
Practice Address - Phone:757-659-9903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty