Healthcare Provider Details

I. General information

NPI: 1992639728
Provider Name (Legal Business Name): KETARA COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 E MAIN ST STE 200
ROCK HILL SC
29730-5384
US

IV. Provider business mailing address

7108 S KANNER HWY # 7462
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 833-876-1455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: