Provider Demographics
NPI:1588481501
Name:OVESON, MCKINSEY (RDN)
Entity type:Individual
Prefix:
First Name:MCKINSEY
Middle Name:
Last Name:OVESON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:MCKINSEY
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:12889 S COTTAGE OAK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-1877
Mailing Address - Country:US
Mailing Address - Phone:801-633-8235
Mailing Address - Fax:
Practice Address - Street 1:12889 S COTTAGE OAK DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-1877
Practice Address - Country:US
Practice Address - Phone:801-633-8235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9475872-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty