Healthcare Provider Details

I. General information

NPI: 1215514781
Provider Name (Legal Business Name): MADISON RIES COOKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 N ELM ST
HENDERSON KY
42420-2768
US

IV. Provider business mailing address

PO BOX 632111
CINCINNATI OH
45263-2111
US

V. Phone/Fax

Practice location:
  • Phone: 270-831-7937
  • Fax: 270-831-7939
Mailing address:
  • Phone:
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01101173A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number59958
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: