Provider Demographics
NPI:1003997412
Name:COOPER, LISA RUTH (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RUTH
Last Name:COOPER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-3401
Mailing Address - Country:US
Mailing Address - Phone:865-689-9060
Mailing Address - Fax:
Practice Address - Street 1:1915 WHITE AVE
Practice Address - Street 2:THOMPSON CANCER SURVIVAL CENTER
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2300
Practice Address - Country:US
Practice Address - Phone:865-541-2036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN754133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered