Provider Demographics
NPI:1437774890
Name:MCKENZIE, KYLIE ANNE (MS RDN LDN)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:ANNE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MS RDN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ADMIRALS WAY UNIT 1841
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-5241
Mailing Address - Country:US
Mailing Address - Phone:215-280-7238
Mailing Address - Fax:
Practice Address - Street 1:800 ADMIRALS WAY UNIT 1841
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-5241
Practice Address - Country:US
Practice Address - Phone:215-280-7238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006950133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered