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General NPI Number Information
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NPI Number | 1740450139
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Entity Type | Individual
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Provider Name | STEPHANIE LEE-ANNE FAYARD RD
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Gender | Female
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 10614 LIMU WAY
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City | DIAMONDHEAD
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State | MS
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Zip | 39525-4313
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Country | US
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Telephone | 850-499-0988
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Fax |
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Provider Business Mailing Address
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Address Line | 10614 LIMU WAY
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City | DIAMONDHEAD
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State | MS
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Zip | 39525-4313
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Country | US
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Telephone | 850-499-0988
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 853196
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License Number State |
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