Provider Demographics
NPI:1912334442
Name:PEADEN, ASHLEY (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:PEADEN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1850 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-413-6683
Mailing Address - Fax:252-830-0558
Practice Address - Street 1:1850 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5704
Practice Address - Country:US
Practice Address - Phone:252-413-6683
Practice Address - Fax:252-830-0558
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004266133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ45232AMedicare PIN