Basic Information
Provider Information | |||||||||
NPI: | 1841407269 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COOKE | ||||||||
FirstName: | JOANNE | ||||||||
MiddleName: | LEE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS,RD,LD,CSR | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4801 E LINWOOD BLVD | ||||||||
Address2: | DIALYSIS M6-364 KANSAS CITY VA MED CENTER | ||||||||
City: | KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 64128 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8168614700 | ||||||||
FaxNumber: | 8169224640 | ||||||||
Practice Location | |||||||||
Address1: | 4801 E LINWOOD BLVD | ||||||||
Address2: | DIALYSIS M6-364 | ||||||||
City: | KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 64128 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8168614700 | ||||||||
FaxNumber: | 8169224640 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/16/2007 | ||||||||
LastUpdateDate: | 08/27/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1005X | 2002022941 | MO | N |   | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal | 133VN1005X | RD659219 |   | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal |
No ID Information.