Healthcare Provider Details

I. General information

NPI: 1790870970
Provider Name (Legal Business Name): DARCY C COOKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 MONTGOMERY BLVD NE LOVELACE MEDICAL GROUP BREAST CARE CENTER
ALBUQUERQUE NM
87109-1219
US

IV. Provider business mailing address

4701 MONTGOMERY BLVD NE BREAST CARE CENTER
ALBUQUERQUE NM
87109-1219
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-6900
  • Fax: 505-727-6913
Mailing address:
  • Phone: 505-727-6900
  • Fax: 505-727-6913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2003-0015
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: