Provider Demographics
NPI:1861794513
Name:BEAIRD, EMILY R (MS, RD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:BEAIRD
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-471-7994
Practice Address - Fax:251-471-7451
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1667133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered