1205131539 NPI number — ASHLEY NUTT CLARK NP

Table of content: ASHLEY NUTT CLARK NP (NPI 1205131539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205131539 NPI number — ASHLEY NUTT CLARK NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARK
Provider First Name:
ASHLEY
Provider Middle Name:
NUTT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NUTT
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205131539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SONA DERMATOLOGY
Provider Second Line Business Mailing Address:
7100 COMMERCE WAY SUITE 160
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-904-2191
Provider Business Mailing Address Fax Number:
615-270-1777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SONA DERMATOLOGY
Provider Second Line Business Practice Location Address:
7100 COMMERCE WAY SUITE 160
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-661-8818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  15579 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LW0102X , with the licence number: 15579 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)