Healthcare Provider Details

I. General information

NPI: 1275647042
Provider Name (Legal Business Name): REBECCA V SMITH LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 IRISH BEND ROAD
FRANKLIN LA
70538-3145
US

IV. Provider business mailing address

4370 IRISH BEND ROAD
FRANKLIN LA
70538-3145
US

V. Phone/Fax

Practice location:
  • Phone: 337-519-4498
  • Fax:
Mailing address:
  • Phone: 337-519-4498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number894360
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: