Janette Sue Cooke – Registered Dietitian

Key facts

NPI: 1497215982
Entity type: Individual (NPI type 1)
Primary specialty: Registered Dietitian 133V00000X
License: 913470 (CA)
Practice address: 90 Hope Dr
Mountain Home Afb, ID 83648-1057
Phone: (208) 828-1238
NPI assigned: Mar 21, 2019
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Fay Nutrition Registered Dietitian · San Francisco, CA · NPI 1104334465

NPD (past) DIETITIAN, REGISTERED

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Philosophy

State licenses

License	State	Type	Specialty
913470	CA	MD	Registered Dietitian

Practice roles

Organization	Specialty	Status	New patients
Fay Nutrition	Dietitian, Registered	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Registered Dietitian	133V00000X
Registered Dietitian Group: 193400000X SINGLE SPECIALTY GROUP	133V00000X	913470	CA	Yes

Addresses

Primary practice location

90 Hope Dr
Mountain Home Afb, ID 83648-1057

Mailing address

5695 S Pepperview Way
Boise, ID 83709-4978
Phone (949) 232-6497

Other names

Janette Sue McMillin Former name

Other providers in Mountain Home Afb, ID

Susanna Castleberry, LCSW
Kyle Christensen, D.M.D.
Thomas Michael Christy, D.D.S
Charlie Ann Collenborne, M.D.
Noah Comstock
Lauren Christine Crim
Chad Luckett Crossley, PT, DPT, MS, OCS, AT
Derek J Dutson, D.M.D.
Le Ann Marie Egan
Zane Elliott, IDMT

All providers in Mountain Home Afb, ID · Registered Dietitian in Idaho

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.