Healthcare Provider Details

I. General information

NPI: 1598691297
Provider Name (Legal Business Name): SHELBY MORGAN COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W VINE ST APT A
MOUNT VERNON OH
43050-3104
US

IV. Provider business mailing address

801 W VINE ST APT A
MOUNT VERNON OH
43050-3104
US

V. Phone/Fax

Practice location:
  • Phone: 740-485-4744
  • Fax:
Mailing address:
  • Phone: 740-485-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberVK673521
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: