Provider Demographics
NPI:1467597278
Name:COVINGTON, STACY CADDELL (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:CADDELL
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8500
Mailing Address - Country:US
Mailing Address - Phone:910-715-1010
Mailing Address - Fax:910-715-1026
Practice Address - Street 1:155 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8710
Practice Address - Country:US
Practice Address - Phone:910-255-3668
Practice Address - Fax:910-255-3695
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002960133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered