Provider Demographics
NPI:1740483544
Name:BUBERT, ASHLEY L (RD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:BUBERT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:L
Other - Last Name:LAMMERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6613 QUAIL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-7949
Mailing Address - Country:US
Mailing Address - Phone:972-775-6436
Mailing Address - Fax:
Practice Address - Street 1:1507 HILLVIEW DR
Practice Address - Street 2:CKD SERVICES OF HILLSBORO
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2746
Practice Address - Country:US
Practice Address - Phone:254-582-5577
Practice Address - Fax:254-582-5442
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06655133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F5986OtherMEDICARE INDIVIDUAL PTAN