MEDICARE: ASHLEY NICOLE ATKINSON RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1518723576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICOLE ATKINSON RDN

Provider Business Mailing Address
First Line	:	5926 RIDGEBROOK AVE SE
Second Line	:
City	:	KENTWOOD
State	:	MI
Zip	:	49508-6259
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5926 RIDGEBROOK AVE SE
Second Line	:
City	:	KENTWOOD
State	:	MI
Zip	:	49508-6259
Country	:	US
Telephone Number	:	248-622-7775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	04/06/2026

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