Provider Demographics
NPI:1174255814
Name:SMOOT, SHAWNA J (RDN)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:J
Last Name:SMOOT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:J
Other - Last Name:KONEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:428 GOOSEBERRY RD
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-9008
Mailing Address - Country:US
Mailing Address - Phone:480-285-5662
Mailing Address - Fax:
Practice Address - Street 1:1440 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1505
Practice Address - Country:US
Practice Address - Phone:605-644-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0828133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered