Healthcare Provider Details

I. General information

NPI: 1932424652
Provider Name (Legal Business Name): LOU COOK KLINE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 N WALNUT ST
HARTFORD CITY IN
47348-1364
US

IV. Provider business mailing address

PO BOX 306417
NASHVILLE TN
37230-6417
US

V. Phone/Fax

Practice location:
  • Phone: 931-253-1110
  • Fax:
Mailing address:
  • Phone: 931-253-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003226
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: