Healthcare Provider Details

I. General information

NPI: 1245143700
Provider Name (Legal Business Name): AUTUMN SMITH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

6906 ROE ST
CINCINNATI OH
45227-2612
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-3150
  • Fax:
Mailing address:
  • Phone: 518-496-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86069895
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.10195
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: