Healthcare Provider Details

I. General information

NPI: 1861357550
Provider Name (Legal Business Name): ASHLEY NICOLE BURGESS RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY NICOLE DOHRN

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9599 SE 232ND ST
LATHROP MO
64465-8568
US

IV. Provider business mailing address

9599 SE 232ND ST
LATHROP MO
64465-8568
US

V. Phone/Fax

Practice location:
  • Phone: 913-704-8236
  • Fax:
Mailing address:
  • Phone: 913-704-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2018044602
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: