Individual provider Active NPI

Mackenzie Marie Lane, RD

  • Registered Dietitian
  • Charlotte, NC
National Provider Identifier
1629855663
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
86174533 Issued in CT
Practice address
1001 Blythe Blvd
Charlotte, NC 28203-5866
Phone
(704) 381-8840
NPI assigned
Sep 13, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 86174533 CT Primary

Addresses

Primary practice location

1001 Blythe Blvd
Charlotte, NC 28203-5866

Mailing address

1315 East Blvd
Charlotte, NC 28203-5975
Phone (860) 710-5870

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
86174533CTMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center CurrentSince Feb 3, 2025 Accepting new patients
Carolinas Medical Center CurrentSince Feb 3, 2025 Accepting new patients
Carolinas Medical Center Current Accepting new patients
Nourish, Inc. Dietitian, Registered Past Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1629855663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 EAST BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035975",
            "telephone_number": "860-710-5870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035866",
            "telephone_number": "704-381-8840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE",
        "first_name": "MACKENZIE",
        "middle_name": "MARIE",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-13",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CT",
            "license": "86174533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.