Provider Demographics
NPI:1770338592
Name:RENO-SMITH, ALYSSUM M
Entity type:Individual
Prefix:
First Name:ALYSSUM
Middle Name:M
Last Name:RENO-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4569 MAYSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:AL
Mailing Address - Zip Code:35761
Mailing Address - Country:US
Mailing Address - Phone:509-899-0893
Mailing Address - Fax:
Practice Address - Street 1:4569 MAYSVILLE RD
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:AL
Practice Address - Zip Code:35761
Practice Address - Country:US
Practice Address - Phone:509-899-0893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5283133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics