Provider Demographics
NPI:1912496167
Name:STICKLEY, ASHLEY REED (RD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:REED
Last Name:STICKLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ASHELY
Other - Middle Name:
Other - Last Name:KINDERVATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 TREEMONT CT APT 1925
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-7080
Mailing Address - Country:US
Mailing Address - Phone:804-248-8305
Mailing Address - Fax:
Practice Address - Street 1:1577 LASKIN RD STE 105
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451
Practice Address - Country:US
Practice Address - Phone:757-422-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered