Healthcare Provider Details

I. General information

NPI: 1821301912
Provider Name (Legal Business Name): INGRID GUAY COOK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 N 18TH ST
MONROE LA
71201-4420
US

IV. Provider business mailing address

1006 HIGHLAND AVE
SHREVEPORT LA
71101-4103
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-7999
  • Fax:
Mailing address:
  • Phone: 318-222-6226
  • Fax: 318-524-7252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP06191
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPO6191
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: