Provider Demographics
NPI:1558839100
Name:MACKINNON, SAMANTHA M (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:M
Last Name:MACKINNON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:M
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1369 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-4568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1369 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4568
Practice Address - Country:US
Practice Address - Phone:470-533-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076848133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered