Provider Demographics
NPI:1992551238
Name:HACKERT, ASHLEY R (RDN, CDCES)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:HACKERT
Suffix:
Gender:F
Credentials:RDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6190 SIERRA GRANDE PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3883
Mailing Address - Country:US
Mailing Address - Phone:262-707-6796
Mailing Address - Fax:
Practice Address - Street 1:2502 E PIKES PEAK AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6089
Practice Address - Country:US
Practice Address - Phone:262-707-6796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86020833133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered