Provider Demographics
NPI:1801240791
Name:EDWARDS, ASHLEY JEFFERSON (RD, LDN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JEFFERSON
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3222
Mailing Address - Country:US
Mailing Address - Phone:252-940-5087
Mailing Address - Fax:252-946-8430
Practice Address - Street 1:1436 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3222
Practice Address - Country:US
Practice Address - Phone:252-940-5087
Practice Address - Fax:252-946-8430
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003724133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered