MEDICARE: KENNEDY RICHARD THOMAS HARRIS RDN. 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	133VN1501X	Sports Dietetics Nutrition Registered Dietitian		TX
2	133VN1005X	Renal Nutrition Registered Dietitian		TX

General Provider Information

NPI Number	:	1992561278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNEDY RICHARD THOMAS HARRIS RDN. LD

Provider Business Mailing Address
First Line	:	7137 ORIZABA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-2204
Country	:	US
Telephone Number	:	915-920-7599
Fax Number	:

Provider Business Practice Location Address
First Line	:	7137 ORIZABA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-2204
Country	:	US
Telephone Number	:	915-920-7599
Fax Number	:

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

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	02/26/2024

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