MEDICARE:

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1326984311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:

Provider Business Mailing Address
First Line	:	6204 BLACKSTONE DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-7808
Country	:	US
Telephone Number	:	430-755-0994
Fax Number	:	214-310-4495

Provider Business Practice Location Address
First Line	:	6401 ELDORADO PKWY STE 334
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-6520
Country	:	US
Telephone Number	:	430-755-0994
Fax Number	:	214-310-4495

Authorized Official
Title or Position	:	OWNER
Name	:	MCKENZIE HARRIS
Credential	:	RD, LD, CEDS
Telephone Number	:	214-802-7118

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	04/24/2026

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