Healthcare Provider Details

I. General information

NPI: 1720887003
Provider Name (Legal Business Name): MR. RAY ROBERT COOK III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14125 SR 530 NE
ARLINGTON WA
98223-9335
US

IV. Provider business mailing address

14125 SR 530 NE
ARLINGTON WA
98223-9335
US

V. Phone/Fax

Practice location:
  • Phone: 425-577-1502
  • Fax:
Mailing address:
  • Phone: 425-577-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-4208768
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: