Stacy M Fairey, RDN

Primary specialty

Sports Dietetics Nutrition Registered DietitianTaxonomy code 133VN1501X

Practice address

1805 Clark Hills Cir
Johns Island, SC 29455-7603

Phone

(843) 860-0683

NPI assigned

Apr 17, 2020

Last updated

Apr 17, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1033739214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 CLARK HILLS CIR",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "294557603",
            "telephone_number": "843-860-0683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 CLARK HILLS CIR",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "294557603",
            "telephone_number": "843-860-0683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIREY",
        "first_name": "STACY",
        "middle_name": "M",
        "credential": "RDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-17",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1501X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Sports Dietetics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Dietetics Nutrition Registered Dietitian in Johns Island, SC
• Providers in Johns Island, SC by specialty
• Sports Dietetics Nutrition Registered Dietitian in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.