Healthcare Provider Details

I. General information

NPI: 1821417106
Provider Name (Legal Business Name): ASHLEY KRZYSIK GARRISON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W WEBB AVE
BURLINGTON NC
27217-3706
US

IV. Provider business mailing address

530 W WEBB AVE
BURLINGTON NC
27217-3706
US

V. Phone/Fax

Practice location:
  • Phone: 336-228-8316
  • Fax:
Mailing address:
  • Phone: 336-228-8316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number86053891
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberL006443
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: