Basic Information
| Provider Information | |||||||||
| NPI: | 1225367667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIBLEY | ||||||||
| FirstName: | KRISTA | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 159 COUNTRY WOOD LN | ||||||||
| Address2: | APT # 2 | ||||||||
| City: | COLLINSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240782886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033875196 | ||||||||
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| Practice Location | |||||||||
| Address1: | 320 HOSPITAL DRIVE | ||||||||
| Address2: | MEMORIAL HOSPITAL OF MARTINSVILLE | ||||||||
| City: | MARTINSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766667200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2009 | ||||||||
| LastUpdateDate: | 12/14/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 1038506 | NH | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.