Provider Demographics
NPI:1184462939
Name:JULIAN, ASHTON BROOKE (RDN)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:BROOKE
Last Name:JULIAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 W DADE 62
Mailing Address - Street 2:
Mailing Address - City:LOCKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65682-9774
Mailing Address - Country:US
Mailing Address - Phone:417-299-3975
Mailing Address - Fax:
Practice Address - Street 1:1425 N PERSHING ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5094
Practice Address - Country:US
Practice Address - Phone:417-299-3975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1944133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered