NPIMap

Individual provider Active NPI

Stacey Dunn Ethridge, MS, RDN, LDN

  • Registered Dietitian
  • Decatur, AL
National Provider Identifier
1629621362
Registry record updated Jul 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
2233 Issued in AL
Practice address
1216 Somerville Rd SE
Decatur, AL 35601-4335
Phone
(256) 340-0012
Fax
(256) 340-1408
NPI assigned
Jul 22, 2019
Last updated
Jul 22, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 2233 AL Primary

Addresses

Primary practice location

1216 Somerville Rd SE
Decatur, AL 35601-4335

Mailing address

1216 Somerville Rd SE
Decatur, AL 35601-4335
Phone (256) 340-0012

Other names 1

  • Ms. Stacey Michelle Dunn Former name

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

LicenseStateTypeSpecialty
2233ALMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1629621362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 SOMERVILLE RD SE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356014335",
            "telephone_number": "256-340-0012",
            "fax_number": "256-340-1408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 SOMERVILLE RD SE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356014335",
            "telephone_number": "256-340-0012",
            "fax_number": "256-340-1408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHRIDGE",
        "first_name": "STACEY",
        "middle_name": "DUNN",
        "name_prefix": "Mrs.",
        "credential": "MS, RDN, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-22",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "AL",
            "license": "2233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "DUNN",
            "middle_name": "MICHELLE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Decatur, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; 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.