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General NPI Number Information
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NPI Number | 1679555940
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Entity Type | Individual
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Provider Name | BEVERLY J STICKLES M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/14/2005
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 721 MADISON ST SE
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City | HUNTSVILLE
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State | AL
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Zip | 35801-4408
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Country | US
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Telephone | 256-880-6711
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Fax | 256-880-6712
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Provider Business Mailing Address
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Address Line | PO BOX 288
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City | HUNTSVILLE
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State | AL
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Zip | 35804-0288
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Country | US
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Telephone | 256-880-6711
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Fax | 256-880-6712
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 160790
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License Number State | MA
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