Provider Demographics
NPI:1518509462
Name:COOK, CASSIE JOANNE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:JOANNE
Last Name:COOK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:CASSIE
Other - Middle Name:JOANNE
Other - Last Name:CONN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:2950 S SERVICE RD APT 4134
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5668
Mailing Address - Country:US
Mailing Address - Phone:618-240-2779
Mailing Address - Fax:
Practice Address - Street 1:909 26TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6366
Practice Address - Country:US
Practice Address - Phone:405-801-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2428133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered