Provider Demographics
NPI:1275647042
Name:SMITH, REBECCA V (LDN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:V
Last Name:SMITH
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 IRISH BEND ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-3145
Mailing Address - Country:US
Mailing Address - Phone:337-519-4498
Mailing Address - Fax:
Practice Address - Street 1:4370 IRISH BEND ROAD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-3145
Practice Address - Country:US
Practice Address - Phone:337-519-4498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA894360133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered