Provider Demographics
NPI:1992317812
Name:SMITH, ABIGAIL R (RD, CSO, LD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD, CSO, LD
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, CSO, LD
Mailing Address - Street 1:3909 GRAF DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2563
Mailing Address - Country:US
Mailing Address - Phone:937-212-8328
Mailing Address - Fax:
Practice Address - Street 1:529 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3229
Practice Address - Country:US
Practice Address - Phone:502-377-7099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1301X
86072962133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology