Healthcare Provider Details

I. General information

NPI: 1841035847
Provider Name (Legal Business Name): KAYLEY W COOK BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 06/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2854 NW RALEIGH ST
PORTLAND OR
97210-2465
US

IV. Provider business mailing address

3455 SW US VETERANS HOSPITAL RD
PORTLAND OR
97239-3076
US

V. Phone/Fax

Practice location:
  • Phone: 503-799-9660
  • Fax:
Mailing address:
  • Phone: 503-799-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number095000331RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: