MEDICARE: MS. MEGAN BROOKE SMITH RDN/LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian
2	133V00000X	Registered Dietitian	DT82821	TX

General Provider Information

NPI Number	:	1316222326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MEGAN BROOKE SMITH RDN/LD

Provider Business Mailing Address
First Line	:	4221 MAPLE ST
Second Line	:
City	:	VERNON
State	:	TX
Zip	:	76384-3117
Country	:	US
Telephone Number	:	405-271-5501
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 HILLCREST DR
Second Line	:
City	:	VERNON
State	:	TX
Zip	:	76384-3196
Country	:	US
Telephone Number	:	940-553-2106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2011
Last Update Date	:	08/30/2021

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