Provider Demographics
NPI:1952117608
Name:SMITH, ALEXIS (MS, RD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
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 1:162 SIGNAL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37381-3438
Mailing Address - Country:US
Mailing Address - Phone:423-497-2871
Mailing Address - Fax:
Practice Address - Street 1:162 SIGNAL DR
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:TN
Practice Address - Zip Code:37381-3438
Practice Address - Country:US
Practice Address - Phone:423-497-2871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN86329809133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered