Provider Demographics
NPI:1992561278
Name:HARRIS, KENNEDY RICHARD THOMAS (RDN LD)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:RICHARD THOMAS
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RDN LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7137 ORIZABA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2204
Mailing Address - Country:US
Mailing Address - Phone:915-920-7599
Mailing Address - Fax:
Practice Address - Street 1:7137 ORIZABA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2204
Practice Address - Country:US
Practice Address - Phone:915-920-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133VN1501X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics