Provider Demographics
NPI:1417022492
Name:MCKAY, VICKY LYNN (RD)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:LYNN
Last Name:MCKAY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BICENTENNIAL WAY
Mailing Address - Street 2:MOBE SUITE 285B
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2149
Mailing Address - Country:US
Mailing Address - Phone:707-571-3064
Mailing Address - Fax:707-571-3064
Practice Address - Street 1:401 BICENTENNIAL WAY
Practice Address - Street 2:MOBE SUITE 285B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2149
Practice Address - Country:US
Practice Address - Phone:707-571-3064
Practice Address - Fax:707-571-3064
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412654133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered