Provider Demographics
NPI:1306401179
Name:SPIVEY, AMBER NICHOLE (RD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICHOLE
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:NICHOLE
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1467 SISKIYOU BLVD # 2125
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2336
Mailing Address - Country:US
Mailing Address - Phone:336-847-4390
Mailing Address - Fax:
Practice Address - Street 1:602 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-3228
Practice Address - Country:US
Practice Address - Phone:336-847-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86097267133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered