1144496985 NPI number — MRS. CAROL A COOKE CRNP

Table of content: MRS. CAROL A COOKE CRNP (NPI 1144496985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144496985 NPI number — MRS. CAROL A COOKE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOKE
Provider First Name:
CAROL
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144496985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6438 WILMINGTON PIKE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45459-7021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-848-4850
Provider Business Mailing Address Fax Number:
937-848-4858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6438 WILMINGTON PIKE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
CENTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-848-4850
Provider Business Practice Location Address Fax Number:
937-848-4858
Provider Enumeration Date:
05/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  RN212344 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: COA05642NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RX05642 . This is a "CERTIFICATE TO PRESCRIBE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0074036 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: COA05642NP . This is a "LICENSE NP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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