Healthcare Provider Details

I. General information

NPI: 1568765808
Provider Name (Legal Business Name): TAMMY SUE COOK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 S LINDBERGH BLVD STE 205
SAINT LOUIS MO
63127-1372
US

IV. Provider business mailing address

856 DUNBARTON DR
WELDON SPRING MO
63304-1079
US

V. Phone/Fax

Practice location:
  • Phone: 314-616-2526
  • Fax:
Mailing address:
  • Phone: 314-616-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2001000724
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number2001000724
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: