Provider Demographics
NPI:1356079792
Name:DANIEL, ASHTON NICOLE
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:NICOLE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 DEER LODGE HWY
Mailing Address - Street 2:
Mailing Address - City:SUNBRIGHT
Mailing Address - State:TN
Mailing Address - Zip Code:37872-2910
Mailing Address - Country:US
Mailing Address - Phone:423-319-7763
Mailing Address - Fax:
Practice Address - Street 1:239 FOSTER RD
Practice Address - Street 2:
Practice Address - City:ROCKY TOP
Practice Address - State:TN
Practice Address - Zip Code:37769-5559
Practice Address - Country:US
Practice Address - Phone:423-319-7763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4563133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty