Provider Demographics
NPI:1942462874
Name:MCKENZIE, HEATHER D (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:D
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HILTON HEAD DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-8425
Mailing Address - Country:US
Mailing Address - Phone:726-726-3929
Mailing Address - Fax:
Practice Address - Street 1:113 HILTON HEAD DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-8425
Practice Address - Country:US
Practice Address - Phone:972-672-6392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80341133V00000X
LA2612133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered