Basic Information
| Provider Information | |||||||||
| NPI: | 1760706147 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOLEY | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 MITCHELL AVE | ||||||||
| Address2: | PO BOX 226 | ||||||||
| City: | BATESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470068909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129335122 | ||||||||
| FaxNumber: | 8129335252 | ||||||||
| Practice Location | |||||||||
| Address1: | 321 MITCHELL AVE | ||||||||
| Address2: | |||||||||
| City: | BATESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470068909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129335122 | ||||||||
| FaxNumber: | 8129335252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2010 | ||||||||
| LastUpdateDate: | 03/15/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 37001029A | IN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.