Healthcare Provider Details

I. General information

NPI: 1790292159
Provider Name (Legal Business Name): PATRICIA ANN COOK PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA ANN COLLINS PMHNP

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W MAIN ST
MALONE NY
12953-9577
US

IV. Provider business mailing address

213 WEST MAIN STREET MALONE NY
MALONE NY
12953-1246
US

V. Phone/Fax

Practice location:
  • Phone: 518-481-8744
  • Fax: 518-481-8543
Mailing address:
  • Phone: 518-481-8744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402670
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number632597
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: