Healthcare Provider Details

I. General information

NPI: 1740801232
Provider Name (Legal Business Name): AMY SMITH MS, CNS, LDN, BCHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10451 MILL RUN CIR STE 400
OWINGS MILLS MD
21117-5594
US

IV. Provider business mailing address

553 WYNDALE RD
ABINGDON VA
24210-4721
US

V. Phone/Fax

Practice location:
  • Phone: 276-475-8848
  • Fax: 276-222-6916
Mailing address:
  • Phone: 423-863-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX5177
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberCNS18228
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number164.00899
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN-0010852
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN-0010852
License Number StateDE
# 7
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX5177
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.00899
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: