Provider Demographics
NPI:1710971940
Name:MCCANT, KENYA LATRICA (RD)
Entity Type:Individual
Prefix:MS
First Name:KENYA
Middle Name:LATRICA
Last Name:MCCANT
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 1:6300 MOSELEY DIXON RD
Mailing Address - Street 2:APT. 202P
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-8400
Mailing Address - Country:US
Mailing Address - Phone:478-475-0423
Mailing Address - Fax:
Practice Address - Street 1:122A GORDON COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-5740
Practice Address - Country:US
Practice Address - Phone:706-845-4035
Practice Address - Fax:706-845-4309
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002906133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered