Provider Demographics
NPI:1407974132
Name:MCCONVILLE, KECIA BETH (RD, LDN, MPH)
Entity Type:Individual
Prefix:MRS
First Name:KECIA
Middle Name:BETH
Last Name:MCCONVILLE
Suffix:
Gender:F
Credentials:RD, LDN, MPH
Other - Prefix:
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Mailing Address - Street 1:220 FORT SANDERS WEST BLVD
Mailing Address - Street 2:MOB 2, SUITE 205
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922
Mailing Address - Country:US
Mailing Address - Phone:865-531-5590
Mailing Address - Fax:865-531-5596
Practice Address - Street 1:220 FORT SANDERS WEST BLVD
Practice Address - Street 2:MOB 2, SUITE 205
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3398
Practice Address - Country:US
Practice Address - Phone:865-531-5590
Practice Address - Fax:865-531-5596
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1717133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic