Healthcare Provider Details

I. General information

NPI: 1356056899
Provider Name (Legal Business Name): KRISTEN LINDSEY COOK FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN WHIPPLE RN

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PROGRESS PKWY
SULLIVAN MO
63080-2359
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax:
Mailing address:
  • Phone: 660-885-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2010021716
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023001209
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: