Healthcare Provider Details

I. General information

NPI: 1104963370
Provider Name (Legal Business Name): JULIE KAY KOKINAKES RDN, LDN, CSOWM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE KOKINAKES ANDERSON RDN

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL CENTER DR STE 300
MEDFORD OR
97504-4316
US

IV. Provider business mailing address

520 MEDICAL CENTER DR STE 300
MEDFORD OR
97504-4316
US

V. Phone/Fax

Practice location:
  • Phone: 541-930-8900
  • Fax: 541-245-4823
Mailing address:
  • Phone: 541-930-8900
  • Fax: 541-245-4823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number10176152
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: