Individual
STACEY HITESMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CNSD
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 773-2556
(928) 773-2421
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163244
—
AZ
Enumeration date
08/15/2007
Last updated
03/14/2017
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