Healthcare Provider Details

I. General information

NPI: 1144496985
Provider Name (Legal Business Name): CAROL A COOKE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6438 WILMINGTON PIKE SUITE 300
CENTERVILLE OH
45459
US

IV. Provider business mailing address

6438 WILMINGTON PIKE STE 300
CENTERVILLE OH
45459-7021
US

V. Phone/Fax

Practice location:
  • Phone: 937-848-4850
  • Fax: 937-848-4858
Mailing address:
  • Phone: 937-848-4850
  • Fax: 937-848-4858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberRN212344
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA05642NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: