Healthcare Provider Details

I. General information

NPI: 1518056639
Provider Name (Legal Business Name): HOLLY ANNE SMITH M.S., R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S ROWAN AVE
SPENCER NC
28159-2355
US

IV. Provider business mailing address

210 S ROWAN AVE
SPENCER NC
28159-2355
US

V. Phone/Fax

Practice location:
  • Phone: 704-636-0731
  • Fax:
Mailing address:
  • Phone: 704-636-0731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL002636
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: