Healthcare Provider Details

I. General information

NPI: 1194962357
Provider Name (Legal Business Name): LISA L ASHCRAFT-CARR M.S., R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA L ASHCRAFT M.S., R.D., L.D.

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOSPITAL PLZ
CLARKSBURG WV
26301-9316
US

IV. Provider business mailing address

3 HOSPITAL PLZ P.O. BOX 1680
CLARKSBURG WV
26301-9316
US

V. Phone/Fax

Practice location:
  • Phone: 304-624-2506
  • Fax: 304-624-2272
Mailing address:
  • Phone: 304-624-2506
  • Fax: 304-624-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number102
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: