Provider Demographics
NPI:1427432004
Name:JOHNSON, MAKENZIE (MPH, RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:MAKENZIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MPH, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BAYSHORE BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1961
Mailing Address - Country:US
Mailing Address - Phone:713-840-5190
Mailing Address - Fax:713-944-3839
Practice Address - Street 1:3333 BAYSHORE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1961
Practice Address - Country:US
Practice Address - Phone:713-840-5190
Practice Address - Fax:713-944-3839
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83789133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered