Provider Demographics
NPI:1639270176
Name:SMITH, TWYALA (RD CSP LD)
Entity Type:Individual
Prefix:MRS
First Name:TWYALA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD CSP LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6566 DYKES WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1930
Mailing Address - Country:US
Mailing Address - Phone:214-456-2134
Mailing Address - Fax:214-456-6287
Practice Address - Street 1:1935 MOTOR ST
Practice Address - Street 2:CLINICAL NUTRITION
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-2134
Practice Address - Fax:214-456-6287
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04366133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric