Provider Demographics
NPI:1639304660
Name:SMITH, STACEE ANN (RD)
Entity Type:Individual
Prefix:
First Name:STACEE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:STACEE
Other - Middle Name:ANN
Other - Last Name:SPECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:9109 LAWHON ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2712
Mailing Address - Country:US
Mailing Address - Phone:501-960-0876
Mailing Address - Fax:
Practice Address - Street 1:9109 LAWHON ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-2712
Practice Address - Country:US
Practice Address - Phone:501-960-0876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR952133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered