Healthcare Provider Details

I. General information

NPI: 1215816376
Provider Name (Legal Business Name): TRACY A COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 S 96TH ST STE 2
OMAHA NE
68127-1260
US

IV. Provider business mailing address

8212 GRAND AVE
OMAHA NE
68134-3248
US

V. Phone/Fax

Practice location:
  • Phone: 531-466-1275
  • Fax:
Mailing address:
  • Phone: 402-201-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: