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General NPI Number Information
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NPI Number | 1427840354
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Entity Type | Individual
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Provider Name | MAKENZIE MARIE COOK PA
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Gender | Female
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 630 SH 71 SERVICE RD
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City | BASTROP
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State | TX
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Zip | 78602
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Country | US
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Telephone | 737-881-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1099
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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