Healthcare Provider Details

I. General information

NPI: 1104809987
Provider Name (Legal Business Name): JENIFER P COOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 S JACKSON ST
HUGOTON KS
67951-2858
US

IV. Provider business mailing address

1006 S JACKSON ST
HUGOTON KS
67951-2858
US

V. Phone/Fax

Practice location:
  • Phone: 620-544-6186
  • Fax: 620-544-4076
Mailing address:
  • Phone: 620-544-6186
  • Fax: 620-544-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number004-28272
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: