Individual
KRISTINA STICKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN, LD, CHES
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 529-6111
Mailing address
3635 SILVERSTONE DR, IDAHO FALLS, ID 83401-3583
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-1127
ID
Other
Enumeration date
05/22/2020
Last updated
05/22/2020
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