MEDICARE: MRS. RACHITA KENNY CNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1063035327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHITA KENNY CNS

Provider Business Mailing Address
First Line	:	4737 GRAND MASTERS WAY
Second Line	:
City	:	LAKE RIDGE
State	:	VA
Zip	:	22192-5551
Country	:	US
Telephone Number	:	703-855-5506
Fax Number	:

Provider Business Practice Location Address
First Line	:	4737 GRAND MASTERS WAY
Second Line	:
City	:	LAKE RIDGE
State	:	VA
Zip	:	22192-5551
Country	:	US
Telephone Number	:	703-855-5506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	05/21/2020

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