Doctor Name: | STACY LYNN PRUITT |
NPI Number: | 1386708691 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RD, LD |
License Number: | DT07468 |
Business Practice Address: | 3030 North St Suite 201 Beaumont, TX - 777021433 |
Business Phone Number: | 4098922111 |
Business Fax Number: | 4098133848 |
Mailing Address: | 390 Bradford Dr, BEAUMONT |
State: | TX |
Postal Code: | 777071610 |
Phone Number: | 4098669622 |
Fax Number: | |
NPI Enumeration Date: | 12/21/2006 |
NPI Last Update Date: | 04/24/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | DT07468 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |