Provider Demographics
NPI:1346304953
Name:FAULKNER, ASHLEY W (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:W
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SPANN DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8752
Mailing Address - Country:US
Mailing Address - Phone:601-919-0972
Mailing Address - Fax:601-919-0974
Practice Address - Street 1:105 SPANN DR
Practice Address - Street 2:SUITE C
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-8752
Practice Address - Country:US
Practice Address - Phone:601-919-0972
Practice Address - Fax:601-919-0974
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1193133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered