MEDICARE: STACEY WOOD RDLD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DT06458	TX

General Provider Information

NPI Number	:	1306180286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY WOOD RDLD

Provider Business Mailing Address
First Line	:	PO BOX 856
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-0856
Country	:	US
Telephone Number	:	817-381-8679
Fax Number	:	817-381-4159

Provider Business Practice Location Address
First Line	:	971 HILLTOP DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5845
Country	:	US
Telephone Number	:	817-602-5909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2012
Last Update Date	:	02/07/2023

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