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General NPI Number Information
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NPI Number | 1063058808
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Entity Type | Individual
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Provider Name | KATIE REBECCA CONRAD MCCOY RDN, LD
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Gender | Female
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Dates
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Enumeration Date | 11/26/2019
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 2200 MIAMI VALLEY DR
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City | DAYTON
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State | OH
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Zip | 45459
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Country | US
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Telephone | 937-765-1363
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 BLEDSOE DR
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City | BELLBROOK
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State | OH
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Zip | 45305-1314
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Country | US
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Telephone | 937-765-1363
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 8169
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License Number State | OH
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