Provider Demographics
NPI:1346771789
Name:SMITH, BILLIE LORETTA (MPH, RDN)
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:LORETTA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:LORETTA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPH, RDN
Mailing Address - Street 1:DEPARTMENT OF VETERANS AFFAIRS
Mailing Address - Street 2:1201 NW 16TH STREET
Mailing Address - City:DPO
Mailing Address - State:AP
Mailing Address - Zip Code:33125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 NW 16TH STREET
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125
Practice Address - Country:US
Practice Address - Phone:305-575-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1021858133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered