Basic Information
Provider Information
NPI: 1649713546
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOOKS
FirstName: CASSIE
MiddleName: ARDOIN
NamePrefix:  
NameSuffix:  
Credential: RDN, LD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 661495
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352661495
CountryCode: US
TelephoneNumber: 2059795882
FaxNumber: 2059791248
Practice Location
Address1: 3283 MALCOLM DR
Address2: SUITE 105
City: MONTGOMERY
State: AL
PostalCode: 361168816
CountryCode: US
TelephoneNumber: 3343569970
FaxNumber: 3342698783
Other Information
ProviderEnumerationDate: 11/23/2016
LastUpdateDate: 11/23/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000X2537ALY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


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