MEDICARE: MS. TAMMY SUE COOK RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	2001000724	MO
2	133VN1004X	Pediatric Nutrition Registered Dietitian	2001000724	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568765808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMMY SUE COOK RD

Provider Business Mailing Address
First Line	:	856 DUNBARTON DR
Second Line	:
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-1079
Country	:	US
Telephone Number	:	314-616-2526
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 S LINDBERGH BLVD STE 205
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1372
Country	:	US
Telephone Number	:	314-616-2526
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	09/19/2025

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