Provider Demographics
NPI:1831715069
Name:COOK, MICHELE (RDN)
Entity type:Individual
Prefix:MISS
First Name:MICHELE
Middle Name:
Last Name:COOK
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 1:3122 OWL RD
Mailing Address - Street 2:
Mailing Address - City:DIANA
Mailing Address - State:TX
Mailing Address - Zip Code:75640-4074
Mailing Address - Country:US
Mailing Address - Phone:559-770-5705
Mailing Address - Fax:
Practice Address - Street 1:3122 OWL RD
Practice Address - Street 2:
Practice Address - City:DIANA
Practice Address - State:TX
Practice Address - Zip Code:75640-4074
Practice Address - Country:US
Practice Address - Phone:559-770-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered