Provider Demographics
NPI:1780073569
Name:SMITH, ELIZABETH J (RD/LDN)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD/LDN
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD/LDN
Mailing Address - Street 1:6252 E STAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3704
Mailing Address - Country:US
Mailing Address - Phone:901-219-0816
Mailing Address - Fax:
Practice Address - Street 1:6252 E STAGE PLZ
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3704
Practice Address - Country:US
Practice Address - Phone:901-219-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000040133N00000X, 133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education