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General NPI Number Information
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NPI Number | 1275167710
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Entity Type | Individual
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Provider Name | COURTNEY SMITH RD
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Gender | Female
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Dates
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Enumeration Date | 02/24/2020
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 420 ALABAMA STREET UNIT B
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City | PONCHA SPRINGS
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State | CO
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Zip | 81242
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Country | US
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Telephone | 305-330-1933
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 175
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City | SALIDA
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State | CO
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Zip | 81201-0175
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | ND6361
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License Number State | FL
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