Healthcare Provider Details

I. General information

NPI: 1609539642
Provider Name (Legal Business Name): ASHLEY LUCAS RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2021
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 HAMPTON RD
WASHINGTON IL
61571-1374
US

IV. Provider business mailing address

1302 HAMPTON RD
WASHINGTON IL
61571-1374
US

V. Phone/Fax

Practice location:
  • Phone: 309-573-1880
  • Fax:
Mailing address:
  • Phone: 309-573-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164008113
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: