Healthcare Provider Details

I. General information

NPI: 1336058932
Provider Name (Legal Business Name): SYREETA COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 N CENTRAL EXPY STE 670
DALLAS TX
75204-3158
US

IV. Provider business mailing address

1729 WILLOW CREEK RD
LANCASTER TX
75146-1332
US

V. Phone/Fax

Practice location:
  • Phone: 469-648-0854
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1242472
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: