| Doctor Name: | MRS. JENNIFER KELLER SMITH |
| NPI Number: | 1770705899 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD |
| License Number: | 37001254A |
| Business Practice Address: | 1600 Albany St Beech Grove, IN - 461071541 |
| Business Phone Number: | 3178513841 |
| Business Fax Number: | 3178655083 |
| Mailing Address: | 7164 Bracken Ln, INDIANAPOLIS |
| State: | IN |
| Postal Code: | 462397838 |
| Phone Number: | 3178513841 |
| Fax Number: | 3178655083 |
| NPI Enumeration Date: | 05/02/2007 |
| NPI Last Update Date: | 10/29/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1004X |
| License Number: | 37001254A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Pediatric |
| Taxonomy Definition: | |