Healthcare Provider Details

I. General information

NPI: 1396668596
Provider Name (Legal Business Name): MELINDA COOKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELINDA KERSEY

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12101 N MACARTHUR BLVD STE A
OKLAHOMA CITY OK
73162-1800
US

IV. Provider business mailing address

12101 N MACARTHUR BLVD STE A
OKLAHOMA CITY OK
73162-1800
US

V. Phone/Fax

Practice location:
  • Phone: 405-543-8433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: