Provider Demographics
NPI:1538906623
Name:STICKELMAN, TROY RICHARD
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:RICHARD
Last Name:STICKELMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E REPUBLIC AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-6052
Mailing Address - Country:US
Mailing Address - Phone:785-817-8939
Mailing Address - Fax:
Practice Address - Street 1:415 E REPUBLIC AVE APT 16
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-6052
Practice Address - Country:US
Practice Address - Phone:785-817-8939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program