Provider Demographics
NPI:1891123733
Name:SMITH, LAURA H (RD, LD, CDCES)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD, LD, CDCES
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:H
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LD, CDCES
Mailing Address - Street 1:PO BOX 151735
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78715-1735
Mailing Address - Country:US
Mailing Address - Phone:512-359-8459
Mailing Address - Fax:512-582-2957
Practice Address - Street 1:5900 BALCONES DR # 15580
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4257
Practice Address - Country:US
Practice Address - Phone:512-359-8459
Practice Address - Fax:512-582-2957
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06494133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered