Provider Demographics
NPI:1225659543
Name:VICKERY, HOPE RYAN
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:RYAN
Last Name:VICKERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 S DORSEY LN APT 1063
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3967
Mailing Address - Country:US
Mailing Address - Phone:816-509-6687
Mailing Address - Fax:
Practice Address - Street 1:3255 S DORSEY LN APT 1063
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3967
Practice Address - Country:US
Practice Address - Phone:816-509-6687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered