Provider Demographics
NPI:1952422404
Name:EAVES, AVA MARIE (RD,CDE)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:MARIE
Last Name:EAVES
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:MARIE
Other - Last Name:HATFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 EKU BYPASS
Mailing Address - Street 2:PO BOX1600
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7859
Mailing Address - Country:US
Mailing Address - Phone:859-625-3151
Mailing Address - Fax:859-625-3535
Practice Address - Street 1:801 EASTERN BYPASS
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2751
Practice Address - Country:US
Practice Address - Phone:859-625-3151
Practice Address - Fax:859-625-3535
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0428133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3395129Medicare UPIN