Provider Demographics
NPI:1053939785
Name:SMITH, ASHLEY (LDN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:NUTRITIONAL SERVICES
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-345-2700
Mailing Address - Fax:985-230-7080
Practice Address - Street 1:15790 PAUL VEGA MD DRIVE
Practice Address - Street 2:NUTRITIONAL SERVICES
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-7040
Practice Address - Country:US
Practice Address - Phone:985-345-2700
Practice Address - Fax:985-230-7080
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3134133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered