Provider Demographics
NPI:1285475392
Name:RADY, MACKENZIE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:RADY
Suffix:
Gender:
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:ALSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:706 S ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-4014
Mailing Address - Country:US
Mailing Address - Phone:832-260-6818
Mailing Address - Fax:
Practice Address - Street 1:706 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-4014
Practice Address - Country:US
Practice Address - Phone:832-260-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88355133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered