Rebekah Stacy, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT84347 Issued in TX

Practice address

409 N 6TH St
Longview, TX 75601-6536

Phone

(903) 501-1747

NPI assigned

Oct 29, 2024

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Special Health Resources for Texas, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1043209919
  NPD (past)
• Special Health Resources for Texas, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Tyler, TX
  • NPI 1609298132
  NPD (past)

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

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1194547323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2709",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756062709",
            "telephone_number": "903-234-0776",
            "fax_number": "903-234-9769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 N 6TH ST",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756016536",
            "telephone_number": "903-501-1747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACY",
        "first_name": "REBEKAH",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-29",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT84347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Varalaxmi Sreeram, MD
• Nishit Kumar Srivastava, M.D
• Tanya Srivastava
• SS Pharmacy Holdings Inc
• SSL&H Inc
• Mallorie Wilson Stagg
• Christopher William Stanley, PT
• David Edward Stanley, PA-C
• Jay M Stanley, MD
• Jordan G Stanley, MD

• Registered Dietitian in Longview, TX
• Providers in Longview, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.