Provider Demographics
NPI:1649507112
Name:PHILLIPS, ASHLEY (RD/LD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 E ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5705
Mailing Address - Country:US
Mailing Address - Phone:682-582-1874
Mailing Address - Fax:817-599-1805
Practice Address - Street 1:713 E ANDERSON ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5705
Practice Address - Country:US
Practice Address - Phone:682-582-1874
Practice Address - Fax:817-599-1805
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81295133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V5796OtherBCBS
TX206894201Medicaid