| 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 | 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: Accepting Medicare Assignments Practice Location: 600 Main St, Friendship, TN 38034 Phone: 731-677-3400 Fax: 731-677-3402 | |
Madelyne Ellis, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1159 Walter Taylor Rd, Friendship, TN 38034 Phone: 931-787-4062 |