Provider Demographics
NPI:1316222326
Name:SMITH, MEGAN BROOKE (RDN/LD)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:BROOKE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-3117
Mailing Address - Country:US
Mailing Address - Phone:405-271-5501
Mailing Address - Fax:
Practice Address - Street 1:920 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-3196
Practice Address - Country:US
Practice Address - Phone:940-553-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
TXDT82821133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered