Provider Demographics
NPI:1104963370
Name:KOKINAKES, JULIE KAY (RDN, LDN, CSOWM)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:KAY
Last Name:KOKINAKES
Suffix:
Gender:F
Credentials:RDN, LDN, CSOWM
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:KOKINAKES
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:520 MEDICAL CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4316
Mailing Address - Country:US
Mailing Address - Phone:541-930-8900
Mailing Address - Fax:541-245-4823
Practice Address - Street 1:520 MEDICAL CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4316
Practice Address - Country:US
Practice Address - Phone:541-930-8900
Practice Address - Fax:541-245-4823
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10176152133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered