Provider Demographics
NPI:1295159721
Name:MCKAY, JONI LEE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:JONI
Middle Name:LEE
Last Name:MCKAY
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 1:3111 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-2231
Mailing Address - Country:US
Mailing Address - Phone:319-524-2902
Mailing Address - Fax:
Practice Address - Street 1:3111 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-2231
Practice Address - Country:US
Practice Address - Phone:319-524-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001755133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered