Provider Demographics
NPI:1568821817
Name:STONER-DAVIS, KERSTINA (MS, RDN, LD)
Entity Type:Individual
Prefix:MS
First Name:KERSTINA
Middle Name:
Last Name:STONER-DAVIS
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:MS
Other - First Name:KERI
Other - Middle Name:
Other - Last Name:STONER-DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RDN, LD
Mailing Address - Street 1:700 E PARK BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5472
Mailing Address - Country:US
Mailing Address - Phone:972-422-9170
Mailing Address - Fax:888-821-2292
Practice Address - Street 1:700 E PARK BLVD STE 206
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5472
Practice Address - Country:US
Practice Address - Phone:972-422-9180
Practice Address - Fax:888-821-2292
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06269133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX367548001Medicaid