=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255754255
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY PLYLER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2014
-----------------------------------------------------
Last Update Date | 01/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 SCHNEIDER DR
-----------------------------------------------------
City | MALVERN
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72104-4811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-332-1064
-----------------------------------------------------
Fax | 501-332-7054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 SCHNEIDER DR
-----------------------------------------------------
City | MALVERN
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72104-4811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-332-1064
-----------------------------------------------------
Fax | 501-332-7054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 1418
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------