Healthcare Provider Details

I. General information

NPI: 1629648548
Provider Name (Legal Business Name): FRANCES DARLENE STALEY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 BUCKEYSTOWN PIKE STE 250
FREDERICK MD
21704-8344
US

IV. Provider business mailing address

PO BOX 431
FLORENCE MS
39073-0431
US

V. Phone/Fax

Practice location:
  • Phone: 240-288-3715
  • Fax:
Mailing address:
  • Phone: 601-891-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: