Provider Demographics
NPI:1184188955
Name:CALDWELL, MCKENZIE GABRIELLE (MPH, RDN)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:GABRIELLE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HAWTHORNE LN STE 110
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2358
Mailing Address - Country:US
Mailing Address - Phone:704-916-9329
Mailing Address - Fax:
Practice Address - Street 1:525 N TRYON ST STE 1600
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-0213
Practice Address - Country:US
Practice Address - Phone:704-916-9329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86057198133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered