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NPI Code Detail

MEDICARE: STACY RUTER COVEY R.D., L.D.

MEDICARE: STACY RUTER COVEY R.D., L.D.
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 Dietitian2004024556MO

General Provider Information

NPI Number : 1992818652
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY RUTER COVEY R.D., L.D.
Provider Business Mailing Address
First Line : 6454 CHRISTY DRIVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63116
Country : US
Telephone Number : 314-752-7787
Fax Number :
Provider Business Practice Location Address
First Line : 915 NORTH GRAND
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63106-1621
Country : US
Telephone Number : 314-652-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 07/08/2007

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