Healthcare Provider Details

I. General information

NPI: 1376211284
Provider Name (Legal Business Name): ASHLEY R CARPENTER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LASALLE AVE
KENMORE NY
14217-2641
US

IV. Provider business mailing address

PO BOX 831
GRAND ISLAND NY
14072-0831
US

V. Phone/Fax

Practice location:
  • Phone: 716-946-1484
  • Fax: 716-626-1236
Mailing address:
  • Phone: 716-704-0684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number86118793
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: