=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487519054
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COOK FAMILY MEDICINE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2025
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4518 W PARK ST
-----------------------------------------------------
City | LAVEEN
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85339-4279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-503-6350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4518 W PARK ST
-----------------------------------------------------
City | LAVEEN
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85339-4279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-503-6350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | SALAHUDEEN Y JONES COOK
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 602-503-6350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------