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General NPI Number Information
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NPI Number | 1225367667
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Entity Type | Individual
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Provider Name | KRISTA SHIBLEY RD
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Gender | Female
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 320 HOSPITAL DRIVE MEMORIAL HOSPITAL OF MARTINSVILLE
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City | MARTINSVILLE
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State | VA
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Zip | 24112
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Country | US
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Telephone | 276-666-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 159 COUNTRY WOOD LN APT # 2
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City | COLLINSVILLE
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State | VA
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Zip | 24078-2886
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Country | US
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Telephone | 603-387-5196
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1038506
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License Number State | NH
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