Provider Demographics
NPI:1750092243
Name:MENDEZ GARCIA, ASHLEY VANESSA (LDN, RDN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:VANESSA
Last Name:MENDEZ GARCIA
Suffix:
Gender:F
Credentials:LDN, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 ELK CV
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-5144
Mailing Address - Country:US
Mailing Address - Phone:901-409-5028
Mailing Address - Fax:
Practice Address - Street 1:2071 ELK CV
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-5144
Practice Address - Country:US
Practice Address - Phone:901-409-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4214133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered