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NPI Code Detail

MEDICARE: MRS. TRACY STIVERS MS RD

MEDICARE: MRS. TRACY STIVERS MS RD
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
1133V00000XRegistered Dietitian0370KY

General Provider Information

NPI Number : 1891867099
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACY STIVERS MS RD
Provider Business Mailing Address
First Line : PO BOX 555
Second Line :
City : MANCHESTER
State : KY
Zip : 40962
Country : US
Telephone Number : 606-598-3836
Fax Number :
Provider Business Practice Location Address
First Line : 376 MANCHESTER SQUARE
Second Line :
City : MANCHESTER
State : KY
Zip : 40962-9998
Country : US
Telephone Number : 606-598-7673
Fax Number : 606-598-7942
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2006
Last Update Date : 07/08/2007

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