Healthcare Provider Details

I. General information

NPI: 1508647538
Provider Name (Legal Business Name): RUBY SHAREE COOKS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6569 HIGHWAY 84
FERRIDAY LA
71334-4573
US

IV. Provider business mailing address

4319 CARTER ST
VIDALIA LA
71373-3152
US

V. Phone/Fax

Practice location:
  • Phone: 318-757-6551
  • Fax:
Mailing address:
  • Phone: 318-414-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number234573
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: