Individual
MIRANDA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LD
Contact information
Practice address
1400 8TH AVE, FORT WORTH, TX 76104-4110
(817) 922-2034
Mailing address
1400 8TH AVE, FORT WORTH, TX 76104-4110
(817) 922-2034
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT87461
TX
Other
Enumeration date
03/01/2022
Last updated
03/01/2022
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