Provider Demographics
NPI:1548677396
Name:AINSWORTH, MADISON (DIETITIAN)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:AINSWORTH
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-7576
Mailing Address - Fax:228-497-8869
Practice Address - Street 1:1124 OAKLEIGH RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5716
Practice Address - Country:US
Practice Address - Phone:228-875-3778
Practice Address - Fax:228-875-9335
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1491133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered