Provider Demographics
NPI:1093058331
Name:SMITH, NANCY B (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:B
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 VETERANS MEMORIAL DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ADAMSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35005-2260
Mailing Address - Country:US
Mailing Address - Phone:205-674-1222
Mailing Address - Fax:205-674-1230
Practice Address - Street 1:3915 VETERANS MEMORIAL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:ADAMSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35005-2260
Practice Address - Country:US
Practice Address - Phone:205-674-1222
Practice Address - Fax:205-674-1230
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1306133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered