=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710833645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATIE SMITH PHD, RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2026
-----------------------------------------------------
Last Update Date | 03/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24055 170TH AVE
-----------------------------------------------------
City | LACONA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50139-8833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-299-3960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 34
-----------------------------------------------------
City | LACONA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50139-0034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 078165
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------