Active NPI
Stacy Back, MS,RD,LD
- Registered Dietitian
- Somerset, KY
National Provider Identifier
1457768699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1384
- Practice address
- 2441 S Highway 27
Somerset, KY 42501-2935 - Phone
- (606) 677-4068
- NPI assigned
- Jul 21, 2014
- Last updated
- Jul 21, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 | 1384 | KY | Primary |
Addresses
Primary practice location
2441 S Highway 27
Somerset, KY 42501-2935
Mailing address
2441 S Highway 27
Somerset, KY 42501-2935
Phone (606) 677-4068
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1384 | KY | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405900800000",
"number": "1457768699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2441 S HIGHWAY 27",
"city": "SOMERSET",
"state": "KY",
"postal_code": "425012935",
"telephone_number": "606-677-4068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2441 S HIGHWAY 27",
"city": "SOMERSET",
"state": "KY",
"postal_code": "425012935",
"telephone_number": "606-677-4068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACK",
"first_name": "STACY",
"credential": "MS,RD,LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-21",
"last_updated": "2014-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "KY",
"license": "1384",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Somerset, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.