Provider Demographics
NPI:1770470262
Name:LEMONS, MARY KELLISON (RD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KELLISON
Last Name:LEMONS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KELLISON
Other - Last Name:THORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4060 BUENA VISTA ST UNIT D
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-7800
Mailing Address - Country:US
Mailing Address - Phone:770-328-6433
Mailing Address - Fax:
Practice Address - Street 1:5900 S LAKE FOREST DR STE 425
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2193
Practice Address - Country:US
Practice Address - Phone:469-575-5754
Practice Address - Fax:469-294-9175
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT92158133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered