Provider Demographics
NPI:1720446495
Name:JASPER II, RICKEY II (NASM, CPT)
Entity Type:Individual
Prefix:
First Name:RICKEY
Middle Name:
Last Name:JASPER II
Suffix:II
Gender:M
Credentials:NASM, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20707 MANDALAY CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-2836
Mailing Address - Country:US
Mailing Address - Phone:703-967-2186
Mailing Address - Fax:
Practice Address - Street 1:2979 ESCALA CIR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-6723
Practice Address - Country:US
Practice Address - Phone:703-967-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator