MEDICARE: MS. BAILEY ELIZABETH RICHARDS MS, RD, LD

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	3384	AL

General Provider Information

NPI Number	:	1376275164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BAILEY ELIZABETH RICHARDS MS, RD, LD

Provider Business Mailing Address
First Line	:	3849 COLLINE DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-3357
Country	:	US
Telephone Number	:	334-322-2309
Fax Number	:

Provider Business Practice Location Address
First Line	:	3849 COLLINE DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-3357
Country	:	US
Telephone Number	:	334-322-2309
Fax Number	:

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

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	06/29/2022

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