Healthcare Provider Details

I. General information

NPI: 1639009400
Provider Name (Legal Business Name): MAXTON M COOK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 S WALNUT AVE
AMES IA
50010-6974
US

IV. Provider business mailing address

223 S WALNUT AVE
AMES IA
50010-6974
US

V. Phone/Fax

Practice location:
  • Phone: 515-368-7504
  • Fax:
Mailing address:
  • Phone: 515-368-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG191294
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: