Provider Demographics
NPI:1669613147
Name:MCKENNA, RICKI LEE (CN)
Entity type:Individual
Prefix:MS
First Name:RICKI
Middle Name:LEE
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 GRAY FALLS DRIVE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077
Mailing Address - Country:US
Mailing Address - Phone:970-618-7607
Mailing Address - Fax:
Practice Address - Street 1:10811 RICHMOND AVE
Practice Address - Street 2:STE 77
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-6708
Practice Address - Country:US
Practice Address - Phone:970-618-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO607003133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education