Provider Demographics
NPI:1194544536
Name:RHEA, STACEY L (RD, LD, CDCES)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:RHEA
Suffix:
Gender:F
Credentials:RD, LD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 CHANDLER HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5113
Mailing Address - Country:US
Mailing Address - Phone:828-558-1259
Mailing Address - Fax:
Practice Address - Street 1:3323 CHANDLER HOLLOW LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5113
Practice Address - Country:US
Practice Address - Phone:828-558-1259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86687133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered