Provider Demographics
NPI:1992411326
Name:METCALF, BAILEY (RDN, LD)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:METCALF
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:507 DUCHESS LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7780
Mailing Address - Country:US
Mailing Address - Phone:972-757-5396
Mailing Address - Fax:
Practice Address - Street 1:4 AVIGNON CT
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-9104
Practice Address - Country:US
Practice Address - Phone:972-757-5396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86084416133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered