Provider Demographics
NPI:1871358994
Name:STEPHENS, ASHLEY NICOLE WATSON (RD, RDN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE WATSON
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 RUSH MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:VT
Mailing Address - Zip Code:05062-9711
Mailing Address - Country:US
Mailing Address - Phone:409-201-5845
Mailing Address - Fax:
Practice Address - Street 1:289 COUNTY RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VT
Practice Address - Zip Code:05089-9000
Practice Address - Country:US
Practice Address - Phone:802-674-6711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0134456133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered