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General NPI Number Information
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NPI Number | 1407764376
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Entity Type | Individual
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Provider Name | MCKENZIE COFFEE RD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2026
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Last Update Date | 08/31/2026
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Provider Practice Location Address
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Address Line | 4500 S LANCASTER RD RM C3400A
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City | DALLAS
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State | TX
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Zip | 75216-7167
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Country | US
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Telephone | 214-857-6945
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Fax |
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Provider Business Mailing Address
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Address Line | 1409 N ZANG BLVD APT 413
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City | DALLAS
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State | TX
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Zip | 75203-1229
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Country | US
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Telephone |
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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 |
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License Number State |
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