MEDICARE: KRISTINA MARIE MCCARTHY MCN, RD, LD

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	DT85649	TX

General Provider Information

NPI Number	:	1265111959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA MARIE MCCARTHY MCN, RD, LD

Provider Business Mailing Address
First Line	:	11925 SNOW FINCH RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-3307
Country	:	US
Telephone Number	:	810-348-7491
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 SPICEWOOD SPRINGS RD STE 1022
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8543
Country	:	US
Telephone Number	:	512-257-0898
Fax Number	:	512-792-9912

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

Provider Enumeration Date	:	07/12/2023
Last Update Date	:	07/12/2023

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