Provider Demographics
NPI:1609411990
Name:RAMIREZ, MCKENZIE NICOLE
Entity Type:Individual
Prefix:MS
First Name:MCKENZIE
Middle Name:NICOLE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MCKENZIE
Other - Middle Name:NICOLE
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LD
Mailing Address - Street 1:700 E PARK BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8842
Mailing Address - Country:US
Mailing Address - Phone:972-422-9180
Mailing Address - Fax:
Practice Address - Street 1:700 E PARK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8842
Practice Address - Country:US
Practice Address - Phone:972-422-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85543133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered