Healthcare Provider Details

I. General information

NPI: 1396708624
Provider Name (Legal Business Name): NANCY GRAY COOK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E 9TH ST
BONHAM TX
75418-4059
US

IV. Provider business mailing address

283 DAVENPORT RD
SHERMAN TX
75090-3515
US

V. Phone/Fax

Practice location:
  • Phone: 903-583-6716
  • Fax: 903-583-6625
Mailing address:
  • Phone: 903-893-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number233728
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: