Provider Demographics
NPI:1255921136
Name:CLEMENTS, ASHLEY DANIELLE (MS NUTRITION)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:DANIELLE
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:MS NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 WILLOW LEAF LN
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-3629
Mailing Address - Country:US
Mailing Address - Phone:512-644-0931
Mailing Address - Fax:
Practice Address - Street 1:188 WILLOW LEAF LN
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-3629
Practice Address - Country:US
Practice Address - Phone:512-644-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education