Provider Demographics
NPI:1255049078
Name:SMITH, PAMELA PARISH (MS RD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:PARISH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4952 SEQUOIA DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9681
Mailing Address - Country:US
Mailing Address - Phone:269-876-0479
Mailing Address - Fax:
Practice Address - Street 1:3185 KNIGHT WAY SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4406
Practice Address - Country:US
Practice Address - Phone:616-526-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI706239133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered