Healthcare Provider Details

I. General information

NPI: 1639442403
Provider Name (Legal Business Name): RHONDA A MCKINNEY CERT.NUTRITIONIST,CN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 W ABRAM ST SUITE 110
ARLINGTON TX
76013-7049
US

IV. Provider business mailing address

2410 W ABRAM ST SUITE 110
ARLINGTON TX
76013-7049
US

V. Phone/Fax

Practice location:
  • Phone: 817-277-3030
  • Fax: 817-277-3359
Mailing address:
  • Phone: 817-277-3030
  • Fax: 817-277-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number007894
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: