Healthcare Provider Details

I. General information

NPI: 1013095439
Provider Name (Legal Business Name): CAROL MACE STAPLETON R.D. L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 JAMES TRIMBLE BLVD
PAINTSVILLE KY
41240-1026
US

IV. Provider business mailing address

247 E DORTON BLVD
STAFFORDSVILLE KY
41256-9038
US

V. Phone/Fax

Practice location:
  • Phone: 606-789-2590
  • Fax: 606-789-8237
Mailing address:
  • Phone: 606-279-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberKY-1546
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: