Basic Information
| Provider Information | |||||||||
| NPI: | 1952422404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EAVES | ||||||||
| FirstName: | AVA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | R.D.,C.D.E. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HATFIELD | ||||||||
| OtherFirstName: | AVA | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 801 EKU BYPASS | ||||||||
| Address2: | PO BOX1600 | ||||||||
| City: | RICHMOND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404757859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596253151 | ||||||||
| FaxNumber: | 8596253535 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 EASTERN BYPASS | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404752751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596253151 | ||||||||
| FaxNumber: | 8596253535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 01/12/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | KY-0428 | KY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.