Provider Demographics
NPI:1063840932
Name:STONE, BRIANNA (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:BRIANNA
Other - Last Name:CORRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:451 HAYWOOD RD
Mailing Address - Street 2:STE 28
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4304
Mailing Address - Country:US
Mailing Address - Phone:864-631-5869
Mailing Address - Fax:
Practice Address - Street 1:451 HAYWOOD RD
Practice Address - Street 2:STE 28
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4304
Practice Address - Country:US
Practice Address - Phone:864-631-5869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV86007865133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV107849Medicare PIN