Individual
MICKENZIE DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, LDN
Contact information
Practice address
49 KIRK LN, MEDIA, PA 19063-2137
(800) 736-3739
Mailing address
49 KIRK LN, MEDIA, PA 19063-2137
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
01/18/2022
Last updated
08/01/2025
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