Provider Demographics
NPI:1467281048
Name:MCCRACKEN, KARA (MS, RD)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 RAZUKI LN
Mailing Address - Street 2:
Mailing Address - City:JAMUL
Mailing Address - State:CA
Mailing Address - Zip Code:91935-2140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3330 RAZUKI LN
Practice Address - Street 2:
Practice Address - City:JAMUL
Practice Address - State:CA
Practice Address - Zip Code:91935-2140
Practice Address - Country:US
Practice Address - Phone:619-776-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86102396133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered