Healthcare Provider Details

I. General information

NPI: 1790477321
Provider Name (Legal Business Name): THERESE COOK APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E COLLEGE DR
COLBY KS
67701-3702
US

IV. Provider business mailing address

310 E COLLEGE DR
COLBY KS
67701-3716
US

V. Phone/Fax

Practice location:
  • Phone: 785-462-7511
  • Fax:
Mailing address:
  • Phone: 785-462-6184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTMP-161726
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-82217
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: