Healthcare Provider Details

I. General information

NPI: 1912903980
Provider Name (Legal Business Name): LEISA ANN COOK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCY LN STE 201
HOT SPRINGS AR
71913-6457
US

IV. Provider business mailing address

PO BOX 21850
HOT SPRINGS AR
71903-1850
US

V. Phone/Fax

Practice location:
  • Phone: 501-609-2231
  • Fax: 501-623-0921
Mailing address:
  • Phone: 501-609-2231
  • Fax: 501-623-0921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberA01666
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: