Provider Demographics
NPI:1952948952
Name:COOMES, JENNIFER (DCN, CDN)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:COOMES
Suffix:
Gender:F
Credentials:DCN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22845 SE 1ST PL APT 405
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-5038
Mailing Address - Country:US
Mailing Address - Phone:425-505-3090
Mailing Address - Fax:
Practice Address - Street 1:22845 SE 1ST PL APT 405
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-5038
Practice Address - Country:US
Practice Address - Phone:425-505-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61564208133VN1006X
WANU61007385133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education