Healthcare Provider Details

I. General information

NPI: 1003646241
Provider Name (Legal Business Name): EMILY COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 E 300 S STE 106
AMERICAN FORK UT
84003-3845
US

IV. Provider business mailing address

131 N 300 W UNIT 203
ST GEORGE UT
84770-1001
US

V. Phone/Fax

Practice location:
  • Phone: 801-980-2566
  • Fax:
Mailing address:
  • Phone: 702-787-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: