Basic Information
Provider Information | |||||||||
NPI: | 1134318843 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HONEYCUTT | ||||||||
FirstName: | ASHLEY | ||||||||
MiddleName: | MILES | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | L.D.N., R.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MILES | ||||||||
OtherFirstName: | ASHLEY | ||||||||
OtherMiddleName: | LYNNE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LDN,RD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 211 FRIDAY CENTER DR | ||||||||
Address2: | SUITE 2091, ROOM 2094 HEDRICK BUILDING | ||||||||
City: | CHAPEL HILL | ||||||||
State: | NC | ||||||||
PostalCode: | 275179499 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9849741191 | ||||||||
FaxNumber: | 9849741311 | ||||||||
Practice Location | |||||||||
Address1: | 4200 LAKE BOONE TRL | ||||||||
Address2: |   | ||||||||
City: | RALEIGH | ||||||||
State: | NC | ||||||||
PostalCode: | 276076521 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9197841371 | ||||||||
FaxNumber: | 9197841397 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/18/2007 | ||||||||
LastUpdateDate: | 09/14/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | L002818 | NC | N |   | Dietary & Nutritional Service Providers | Nutritionist |   | 133NN1002X | 002818 | NC | N |   | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 133V00000X | L002818 | NC | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   |
ID Information
ID | Type | State | Issuer | Description | Q50640E853 | 01 | NC | MEDICARE PTAN | OTHER | Q50640A | 01 | NC | MEDICARE PTAN | OTHER |