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General NPI Number Information
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NPI Number | 1043445117
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Entity Type | Individual
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Provider Name | ANNETTA JEAN COOKE RD
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Gender | Female
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 1055 CLARKSVILLE ST SUITE 140
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City | PARIS
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State | TX
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Zip | 75460-6097
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Country | US
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Telephone | 903-783-1131
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Fax | 903-783-1186
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Provider Business Mailing Address
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Address Line | 1055 CLARKSVILLE ST SUITE 140
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City | PARIS
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State | TX
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Zip | 75460-6097
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Country | US
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Telephone | 903-783-1131
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Fax | 903-783-1186
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DT03646
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License Number State | TX
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