Provider Demographics
NPI:1609676493
Name:RAYBURN, JOY THOMAS (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:THOMAS
Last Name:RAYBURN
Suffix:
Gender:
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:MARIE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:27220 BAY BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-6658
Mailing Address - Country:US
Mailing Address - Phone:251-604-9496
Mailing Address - Fax:
Practice Address - Street 1:27220 BAY BRANCH DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-6658
Practice Address - Country:US
Practice Address - Phone:251-604-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD-0979133V00000X
LA3594133V00000X
FL9950133V00000X
AL1587133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered