Provider Demographics
NPI:1083278402
Name:MCKENZIE, KAITLIN (MS RDN)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MS RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7231
Mailing Address - Country:US
Mailing Address - Phone:862-377-3279
Mailing Address - Fax:
Practice Address - Street 1:615 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7231
Practice Address - Country:US
Practice Address - Phone:862-377-3279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered