Provider Demographics
NPI:1275369571
Name:PORTER, ASHLEY COAST (RD, LDN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:COAST
Last Name:PORTER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 QUEENSLAND WAY
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7584
Mailing Address - Country:US
Mailing Address - Phone:615-294-7367
Mailing Address - Fax:
Practice Address - Street 1:1307 QUEENSLAND WAY
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7584
Practice Address - Country:US
Practice Address - Phone:615-294-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2068133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered