Provider Demographics
NPI:1801338884
Name:FAST, BAILEY MARTIN (RDN)
Entity type:Individual
Prefix:MS
First Name:BAILEY
Middle Name:MARTIN
Last Name:FAST
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:ELIZABETH
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:236 LEMLEY CIR
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:AL
Mailing Address - Zip Code:35760-9589
Mailing Address - Country:US
Mailing Address - Phone:256-612-0319
Mailing Address - Fax:
Practice Address - Street 1:236 LEMLEY CIR
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:AL
Practice Address - Zip Code:35760-9589
Practice Address - Country:US
Practice Address - Phone:256-612-0319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK116373133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered