Provider Demographics
NPI:1548037757
Name:SMOOT, EMILY PATRICIA BASS (MS RD CSR LD CNSC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:PATRICIA BASS
Last Name:SMOOT
Suffix:
Gender:F
Credentials:MS RD CSR LD CNSC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:PATRICIA
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RD CSR LD CNSC
Mailing Address - Street 1:171 ASHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8908
Mailing Address - Country:US
Mailing Address - Phone:843-792-1414
Mailing Address - Fax:
Practice Address - Street 1:171 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8908
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1907133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered