Individual provider · NPI-1

Mckenna King

Dietitian, Registered · Glendale, AZ

NPI number1770027971
StatusActive
Last updated in NPPESNov 20, 2024

Details

NPI
1770027971
Entity type
Individual (NPI-1)
Name
Mckenna King
Sex
Female
Sole proprietor
No
Enumeration date
Dec 7, 2016
Certification date
Nov 20, 2024
Last updated
Nov 20, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
133V00000X Dietitian, Registered86359292AZYes
171M00000X Case Manager/Care Coordinator––

Practice location

18001 N 79th Ave Ste A12
Glendale, AZ 85308-8398

Phone 623-399-6825

Mailing address

3960 Walnut Dr
Eureka, CA 95503-8938

Phone 707-268-8722

Other practice locations

3960 Walnut Dr
Eureka, CA 95503-8938

Phone 707-268-8722

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