Provider Demographics
NPI:1467340224
Name:SMITH, MANDY (RDN, LDN)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:LEIGH
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:8718 E WILDERNESS WAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6137
Mailing Address - Country:US
Mailing Address - Phone:479-283-1102
Mailing Address - Fax:
Practice Address - Street 1:8718 E WILDERNESS WAY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6137
Practice Address - Country:US
Practice Address - Phone:479-283-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2299133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered