1366896334 NPI number — DR. ASHTON NICOLE BREITHAUPT DO

Table of content: DR. ASHTON NICOLE BREITHAUPT DO (NPI 1366896334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366896334 NPI number — DR. ASHTON NICOLE BREITHAUPT DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREITHAUPT
Provider First Name:
ASHTON
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEIL
Provider Other First Name:
ASHTON
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366896334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 PARK 40 NORTH BLVD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37923-3624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-692-3462
Provider Business Mailing Address Fax Number:
865-670-6333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 PARK 40 NORTH BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37923-3624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-692-3462
Provider Business Practice Location Address Fax Number:
865-670-6333
Provider Enumeration Date:
04/15/2016

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 3979 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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