Provider Demographics
NPI:1285482984
Name:FLINCHUM, MCKENZIE (RD, LD/N)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:FLINCHUM
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 1:2718 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2066
Mailing Address - Country:US
Mailing Address - Phone:772-766-9656
Mailing Address - Fax:
Practice Address - Street 1:2718 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2066
Practice Address - Country:US
Practice Address - Phone:772-766-9656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7669133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered