Healthcare Provider Details

I. General information

NPI: 1205640695
Provider Name (Legal Business Name): MARQUIDA COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 FLORENCE RD STE 10
KILLEEN TX
76541-8512
US

IV. Provider business mailing address

4209 ALAN KENT DR APT A
KILLEEN TX
76549-4535
US

V. Phone/Fax

Practice location:
  • Phone: 601-218-5655
  • Fax:
Mailing address:
  • Phone: 601-218-5655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: