Provider Demographics
NPI:1730929878
Name:DIAZ, ASHLEY (RD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DIAZ
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 1:232 MICKELSON PL
Mailing Address - Street 2:JOHNSON CITY
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615
Mailing Address - Country:US
Mailing Address - Phone:559-285-1794
Mailing Address - Fax:
Practice Address - Street 1:232 MICKELSON PL
Practice Address - Street 2:JOHNSON CITY
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615
Practice Address - Country:US
Practice Address - Phone:559-285-1794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000004693133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered