Provider Demographics
NPI:1285490805
Name:MACKINTOSH, KENDALL (MS, CNS, LDN, INHC)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:MACKINTOSH
Suffix:
Gender:F
Credentials:MS, CNS, LDN, INHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 ROBINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6115
Mailing Address - Country:US
Mailing Address - Phone:240-674-7187
Mailing Address - Fax:
Practice Address - Street 1:6200 ROBINWOOD RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-6115
Practice Address - Country:US
Practice Address - Phone:240-674-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX7060133N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist