Provider Demographics
NPI:1720367998
Name:KADLUBAR, ASHLEY TYSHANN (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TYSHANN
Last Name:KADLUBAR
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:PO BOX 204803
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-4803
Mailing Address - Country:US
Mailing Address - Phone:817-251-0070
Mailing Address - Fax:817-527-6610
Practice Address - Street 1:1056 TEXAN TRL
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3703
Practice Address - Country:US
Practice Address - Phone:817-527-6627
Practice Address - Fax:817-527-6610
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered