Provider Demographics
NPI:1881827186
Name:BOOKER, DOROTHY L (RD,LD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:L
Last Name:BOOKER
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 OHIO AVE
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-6217
Mailing Address - Country:US
Mailing Address - Phone:662-621-5081
Mailing Address - Fax:662-621-5083
Practice Address - Street 1:785 OHIO AVE
Practice Address - Street 2:SUITE 2F
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6217
Practice Address - Country:US
Practice Address - Phone:662-621-5081
Practice Address - Fax:662-621-5083
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1254133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered