Healthcare Provider Details

I. General information

NPI: 1841407269
Provider Name (Legal Business Name): JOANNE LEE COOKE MS,RD,LD,CSR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E LINWOOD BLVD DIALYSIS M6-364
KANSAS CITY MO
64128
US

IV. Provider business mailing address

4801 E LINWOOD BLVD DIALYSIS M6-364 KANSAS CITY VA MED CENTER
KANSAS CITY MO
64128
US

V. Phone/Fax

Practice location:
  • Phone: 816-861-4700
  • Fax: 816-922-4640
Mailing address:
  • Phone: 816-861-4700
  • Fax: 816-922-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number2002022941
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberRD659219
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: