Provider Demographics
NPI:1841407269
Name:COOKE, JOANNE LEE (MS,RD,LD,CSR)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:LEE
Last Name:COOKE
Suffix:
Gender:F
Credentials:MS,RD,LD,CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 E LINWOOD BLVD
Mailing Address - Street 2:DIALYSIS M6-364 KANSAS CITY VA MED CENTER
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64128
Mailing Address - Country:US
Mailing Address - Phone:816-861-4700
Mailing Address - Fax:816-922-4640
Practice Address - Street 1:4801 E LINWOOD BLVD
Practice Address - Street 2:DIALYSIS M6-364
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128
Practice Address - Country:US
Practice Address - Phone:816-861-4700
Practice Address - Fax:816-922-4640
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002022941133VN1005X
RD659219133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal