Active NPI
Stacy Dawn Davison, RD
- Registered Dietitian
- Phoenix, AZ
National Provider Identifier
1336741214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86063969
- Practice address
- 9520 W Palm LN Ste 150
Phoenix, AZ 85037-4454 - Phone
- (602) 584-5444
- Fax
- (602) 584-6202
- NPI assigned
- Nov 15, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86063969 | AZ | Primary |
Addresses
Primary practice location
9520 W Palm LN Ste 150
Phoenix, AZ 85037-4454
Mailing address
9520 W Palm LN Ste 150
Phoenix, AZ 85037-4454
Phone (602) 584-5444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86063969 | AZ | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636675200000",
"number": "1336741214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9520 W PALM LN STE 150",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850374454",
"telephone_number": "602-584-5444",
"fax_number": "602-584-6202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9520 W PALM LN STE 150",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850374454",
"telephone_number": "602-584-5444",
"fax_number": "602-584-6202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVISON",
"first_name": "STACY",
"middle_name": "DAWN",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-15",
"last_updated": "2021-11-12",
"certification_date": "2021-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AZ",
"license": "86063969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.