Provider Demographics
NPI:1639442403
Name:MCKINNEY, RHONDA A (CERTNUTRITIONIST,CN)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:A
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:CERTNUTRITIONIST,CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 W ABRAM ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-7049
Mailing Address - Country:US
Mailing Address - Phone:817-277-3030
Mailing Address - Fax:817-277-3359
Practice Address - Street 1:2410 W ABRAM ST
Practice Address - Street 2:SUITE 110
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-7049
Practice Address - Country:US
Practice Address - Phone:817-277-3030
Practice Address - Fax:817-277-3359
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007894133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist