Provider Demographics
NPI:1790415529
Name:SMITH, EMILY LAUREL (RDN, LD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LAUREL
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 1:520 PEAKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-2054
Mailing Address - Country:US
Mailing Address - Phone:360-460-7102
Mailing Address - Fax:
Practice Address - Street 1:520 PEAKSIDE CIR
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-2054
Practice Address - Country:US
Practice Address - Phone:360-460-7102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86418133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered