Active NPI
Ashlie M Tislow
- Psychiatric/Mental Health Nurse Practitioner
- Lafayette, IN
National Provider Identifier
1609689215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 71016268A
- Practice address
- 5 Executive Dr Ste C2
Lafayette, IN 47905-4867 - Phone
- (765) 418-1849
- NPI assigned
- Jan 28, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 71016268A | IN | Primary |
Addresses
Primary practice location
5 Executive Dr Ste C2
Lafayette, IN 47905-4867
Mailing address
5 Executive Dr Ste C2
Lafayette, IN 47905-4867
Phone (765) 418-1849
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71016268A | IN | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738022400000",
"number": "1609689215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 EXECUTIVE DR STE C2",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479054867",
"telephone_number": "765-418-1849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 EXECUTIVE DR STE C2",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479054867",
"telephone_number": "765-418-1849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TISLOW",
"first_name": "ASHLIE",
"middle_name": "M",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-01-28",
"last_updated": "2025-01-28",
"certification_date": "2025-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "IN",
"license": "71016268A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.