Healthcare Provider Details

I. General information

NPI: 1932851813
Provider Name (Legal Business Name): EMILY RACHEL MCKEY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2022
Last Update Date: 01/22/2022
Certification Date: 01/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36020 WASHOE RD
BONNER MT
59823-9602
US

IV. Provider business mailing address

36020 WASHOE RD
BONNER MT
59823-9602
US

V. Phone/Fax

Practice location:
  • Phone: 406-240-3868
  • Fax:
Mailing address:
  • Phone: 406-240-3868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number805780
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberMED-NUTR-LIC-404
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: