Healthcare Provider Details

I. General information

NPI: 1730230152
Provider Name (Legal Business Name): KERMA LUANN COOK ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SUNSET DR
LA GRANDE OR
97850-1387
US

IV. Provider business mailing address

PO BOX 3290
LA GRANDE OR
97850-7290
US

V. Phone/Fax

Practice location:
  • Phone: 541-963-2328
  • Fax: 541-975-5210
Mailing address:
  • Phone: 541-963-8421
  • Fax: 541-963-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP13179
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200450139NP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30004942
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: