Provider Demographics
NPI:1457351058
Name:MCCONAHY, KENDRA W (RD, LD/N)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:W
Last Name:MCCONAHY
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35065 SMOKETREE LN
Mailing Address - Street 2:
Mailing Address - City:RIDGE MANOR
Mailing Address - State:FL
Mailing Address - Zip Code:33523-9405
Mailing Address - Country:US
Mailing Address - Phone:352-583-5225
Mailing Address - Fax:
Practice Address - Street 1:7050 GALL BLVD
Practice Address - Street 2:C/O NUTRITIONAL SERVICES
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-1347
Practice Address - Country:US
Practice Address - Phone:813-783-6119
Practice Address - Fax:813-715-6697
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4150133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered