Provider Demographics
NPI:1396115697
Name:COOLEY, ROBIN (RDN)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:COOLEY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2985 S STATE HIGHWAY 360 STE 140
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7680
Mailing Address - Country:US
Mailing Address - Phone:972-602-1166
Mailing Address - Fax:
Practice Address - Street 1:2985 S STATE HIGHWAY 360 STE 140
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7680
Practice Address - Country:US
Practice Address - Phone:972-602-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21958133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered