Healthcare Provider Details

I. General information

NPI: 1023565124
Provider Name (Legal Business Name): BARBARA J. COOK, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N KENNEDY ST
WICHITA KS
67235-7701
US

IV. Provider business mailing address

104 N KENNEDY ST
WICHITA KS
67235-7701
US

V. Phone/Fax

Practice location:
  • Phone: 402-314-8328
  • Fax:
Mailing address:
  • Phone: 402-314-8328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number20860
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number04-38755
License Number StateKS

VIII. Authorized Official

Name: BARBARA JUNE COOK
Title or Position: MANAGER
Credential: M.D.
Phone: 402-314-8328