Provider Demographics
NPI:1760260814
Name:MATHIS, ASHLEY KAREN (MS, RDN, CD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KAREN
Last Name:MATHIS
Suffix:
Gender:F
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 E 400 S
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-2152
Mailing Address - Country:US
Mailing Address - Phone:435-503-4361
Mailing Address - Fax:
Practice Address - Street 1:704 E 400 S
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-2152
Practice Address - Country:US
Practice Address - Phone:435-503-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12517750-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered