Provider Demographics
NPI:1306191275
Name:HOOKER, KELLEY (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:
Last Name:HOOKER
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 1:16373 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70819-2804
Mailing Address - Country:US
Mailing Address - Phone:225-925-3606
Mailing Address - Fax:
Practice Address - Street 1:2751 WOODDALE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-7567
Practice Address - Country:US
Practice Address - Phone:225-925-3606
Practice Address - Fax:225-925-3691
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1692133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered