Basic Information
| Provider Information | |||||||||
| NPI: | 1104963370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOKINAKES | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | R.D.N. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ANDERSON | ||||||||
| OtherFirstName: | JULIE | ||||||||
| OtherMiddleName: | KOKINAKES | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | R.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2620 E BARNETT RD | ||||||||
| Address2: | SUITE H | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417898176 | ||||||||
| FaxNumber: | 5417892558 | ||||||||
| Practice Location | |||||||||
| Address1: | 691 MURPHY RD | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975044346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417896460 | ||||||||
| FaxNumber: | 5417896461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 05/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 10176152 | OR | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.