Provider Demographics
NPI:1831690841
Name:EARDLEY, TENIKA LEIGH (RDN)
Entity type:Individual
Prefix:
First Name:TENIKA
Middle Name:LEIGH
Last Name:EARDLEY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GREYBULL
Mailing Address - State:WY
Mailing Address - Zip Code:82426-1504
Mailing Address - Country:US
Mailing Address - Phone:307-679-4639
Mailing Address - Fax:
Practice Address - Street 1:1351 N 8TH ST
Practice Address - Street 2:
Practice Address - City:GREYBULL
Practice Address - State:WY
Practice Address - Zip Code:82426-1504
Practice Address - Country:US
Practice Address - Phone:307-679-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-24
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY223133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered