Active NPI
Karin Smith, RDN, LD
- Registered Dietitian
- Fort Wayne, IN
National Provider Identifier
1639903446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2561
- Practice address
- 5175 Coventry Pkwy
Fort Wayne, IN 46804-7121 - Phone
- (260) 209-4436
- NPI assigned
- Aug 26, 2024
- Last updated
- Aug 26, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2561 | OK | Primary |
Addresses
Primary practice location
5175 Coventry Pkwy
Fort Wayne, IN 46804-7121
Mailing address
5175 Coventry Pkwy
Fort Wayne, IN 46804-7121
Phone (260) 209-4436
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2561 | OK | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724630400000",
"number": "1639903446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5175 COVENTRY PKWY",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468047121",
"telephone_number": "260-209-4436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5175 COVENTRY PKWY",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468047121",
"telephone_number": "260-209-4436"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "KARIN",
"name_prefix": "Mrs.",
"credential": "RDN, LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-08-26",
"last_updated": "2024-08-26",
"certification_date": "2024-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "2561",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.