Healthcare Provider Details

I. General information

NPI: 1740106434
Provider Name (Legal Business Name): ASHLYN ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 S FREMONT AVE STE 140
SPRINGFIELD MO
65804-2206
US

IV. Provider business mailing address

2055 S FREMONT AVE STE 140
SPRINGFIELD MO
65804-2206
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-2592
  • Fax: 316-208-4629
Mailing address:
  • Phone: 417-820-2592
  • Fax: 316-208-4629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86101196
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: