MEDICARE: MS. KENDRA W. MCCONAHY R.D., L.D./N.

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	ND4150	FL

General Provider Information

NPI Number	:	1457351058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KENDRA W. MCCONAHY R.D., L.D./N.

Provider Business Mailing Address
First Line	:	35065 SMOKETREE LN
Second Line	:
City	:	RIDGE MANOR
State	:	FL
Zip	:	33523-9405
Country	:	US
Telephone Number	:	352-583-5225
Fax Number	:

Provider Business Practice Location Address
First Line	:	7050 GALL BLVD
Second Line	:	C/O NUTRITIONAL SERVICES
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33541-1347
Country	:	US
Telephone Number	:	813-783-6119
Fax Number	:	813-715-6697

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/08/2007

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