Provider Demographics
NPI:1871901686
Name:BRITT, STEPHANIE EADY (RD)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:EADY
Last Name:BRITT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:E
Other - Last Name:MASTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1217 MCDONALD ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3235
Mailing Address - Country:US
Mailing Address - Phone:931-438-0442
Mailing Address - Fax:931-438-0048
Practice Address - Street 1:1217 MCDONALD ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3235
Practice Address - Country:US
Practice Address - Phone:931-438-0442
Practice Address - Fax:931-438-0048
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133NN1002X
TN1982133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education