Provider Demographics
NPI:1538695630
Name:SMITH, BRITTANY (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10375 COTTAGE CT
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-4746
Mailing Address - Country:US
Mailing Address - Phone:228-424-4814
Mailing Address - Fax:
Practice Address - Street 1:10375 COTTAGE CT
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-4746
Practice Address - Country:US
Practice Address - Phone:228-424-4814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1694133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered