Provider Demographics
NPI:1225367667
Name:SHIBLEY, KRISTA (RD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:SHIBLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 COUNTRY WOOD LN
Mailing Address - Street 2:APT # 2
Mailing Address - City:COLLINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24078-2886
Mailing Address - Country:US
Mailing Address - Phone:603-387-5196
Mailing Address - Fax:
Practice Address - Street 1:320 HOSPITAL DRIVE
Practice Address - Street 2:MEMORIAL HOSPITAL OF MARTINSVILLE
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112
Practice Address - Country:US
Practice Address - Phone:276-666-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1038506133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered