Provider Demographics
NPI:1780196303
Name:MCKINNEY, BETH SUZANNE (RDN)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:SUZANNE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MURFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8504
Mailing Address - Country:US
Mailing Address - Phone:607-592-1019
Mailing Address - Fax:
Practice Address - Street 1:41 MURFIELD DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-8504
Practice Address - Country:US
Practice Address - Phone:607-592-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-05
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY196982OtherACADEMY OF DIETETICS AND NUTRITION