Provider Demographics
NPI:1801489109
Name:ASHTON, JESSICA BAILEY (RD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BAILEY
Last Name:ASHTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 W 2060 N APT 226
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-7615
Mailing Address - Country:US
Mailing Address - Phone:919-901-9912
Mailing Address - Fax:
Practice Address - Street 1:144 W 2060 N APT 226
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7615
Practice Address - Country:US
Practice Address - Phone:919-901-9912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
UT12165038-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered