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Ashley Nichole Self

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

1819 W Clinch Ave Ste 100, Knoxville, TN 37916

PECOS Enrollment

This provider is enrolled in PECOS as ASHLEY SELF.

Based on the most recent information from CMS, provider Ashley Nichole Self is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 11:00 AM.

Profile Details

Provider ID
1487990859
Provider Type
Individual
Full Name
Self, Ashley Nichole
Credential
NP

Gender
Female
Sole Proprietor
No
Enumeration Date
12/12/2012
Last Updated
10/13/2023

Contact Information

Practice Location

1819 W Clinch Ave Ste 100, Knoxville, TN 37916

(865) 524-5365

(865) 673-8007

Mailing Location

PO Box 306556, Nashville, TN 37230-6556

(865) 243-8153

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License APN0000016921 Tennessee

Provider Identifiers

ID	Description	Issuer
ID 1530802	Description Medicaid	Issuer Unlisted Tennessee

Ashley Nichole Self

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Haynes, Christy

Golliher, Jessica

Huntsinger, Kerry E.

Whisenant, Cynthia

Wall, Rachal

Langstone, Katy

Henderson, Afeni D.

White, Catherine

Harvey, Sarah A

Cantrill, Deena