Individual
STACY BACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,RD,LD
Contact information
Practice address
2441 S HIGHWAY 27, SOMERSET, KY 42501-2935
(606) 677-4068
Mailing address
2441 S HIGHWAY 27, SOMERSET, KY 42501-2935
(606) 677-4068
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1384
KY
Other
Enumeration date
07/21/2014
Last updated
07/21/2014
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