Provider Demographics
NPI:1740961192
Name:SMITH, SOPHIA (RDN)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 HIGHWAY 377 N STE F
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-3958
Mailing Address - Country:US
Mailing Address - Phone:940-464-5013
Mailing Address - Fax:
Practice Address - Street 1:306 HIGHWAY 377 N STE F
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-3958
Practice Address - Country:US
Practice Address - Phone:940-464-5013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88746133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered