Healthcare Provider Details

I. General information

NPI: 1750205795
Provider Name (Legal Business Name): JORDAN ELIZABETH COOK AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 ROSE DR
COLUMBIA MO
65202-3225
US

IV. Provider business mailing address

2108 ROSE DR
COLUMBIA MO
65202-3225
US

V. Phone/Fax

Practice location:
  • Phone: 573-823-9840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2000725374
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: