Provider Demographics
NPI:1891445961
Name:PAX, ASHLEE (RDN, LD)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:
Last Name:PAX
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:ASHLEE
Other - Middle Name:
Other - Last Name:BESGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:659-358-8027
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:1050 REID PKWY STE 305
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1159
Practice Address - Country:US
Practice Address - Phone:765-983-3423
Practice Address - Fax:765-983-7924
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002511A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered