Basic Information
Provider Information
NPI: 1205353224
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIFORD
FirstName: ASHLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DNP, AGACNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5050 POPLAR AVE
Address2: STE 800
City: MEMPHIS
State: TN
PostalCode: 381570800
CountryCode: US
TelephoneNumber: 9012762662
FaxNumber: 9012742033
Practice Location
Address1: 5050 POPLAR AVE STE 800
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381570800
CountryCode: US
TelephoneNumber: 9012762662
FaxNumber: 9012742033
Other Information
ProviderEnumerationDate: 08/30/2017
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LC0200X22957TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine

No ID Information.


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