Provider Demographics
NPI:1770237588
Name:KOPP, MAKENZIE JILL (MS, RD)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:JILL
Last Name:KOPP
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12748 TIERRA PUEBLO
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4304
Mailing Address - Country:US
Mailing Address - Phone:360-903-7973
Mailing Address - Fax:
Practice Address - Street 1:1ST ARMORED DIVISION, SUSTAINMENT BRIGADE
Practice Address - Street 2:21255 LIGHT INFANTRY BLVD
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-742-9667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered