Healthcare Provider Details

I. General information

NPI: 1225360936
Provider Name (Legal Business Name): STACY ANNE BRISCOE M.S., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PRINGLE WAY STE 505
RENO NV
89502-1469
US

IV. Provider business mailing address

1155 MILL ST # MS 14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5262
  • Fax:
Mailing address:
  • Phone: 775-982-5262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number979831
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number40576-DI-1
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: