Healthcare Provider Details

I. General information

NPI: 1740329077
Provider Name (Legal Business Name): KARA ALLISON COOK APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 PROFESSIONAL BLVD
DALTON GA
30720
US

IV. Provider business mailing address

429 SEATON LOOP
COHUTTA GA
30710
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-5446
  • Fax:
Mailing address:
  • Phone: 706-694-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN145624
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: