Healthcare Provider Details

I. General information

NPI: 1831007459
Provider Name (Legal Business Name): TREVA SMITH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 TROUT LAKE CT
YAKIMA WA
98901-4312
US

IV. Provider business mailing address

813 TROUT LAKE CT
YAKIMA WA
98901-4312
US

V. Phone/Fax

Practice location:
  • Phone: 509-793-4499
  • Fax:
Mailing address:
  • Phone: 509-793-4499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00001789
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: