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General NPI Number Information
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NPI Number | 1720478548
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Entity Type | Individual
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Provider Name | RYAN S COOK APRN
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Gender | Male
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Dates
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Enumeration Date | 02/01/2015
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 540 LINCOLN PARK BLVD SUITE 200
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City | DAYTON
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State | OH
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Zip | 45429-6401
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Country | US
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Telephone | 937-298-8058
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Fax | 937-298-5638
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Provider Business Mailing Address
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Address Line | 540 LINCOLN PARK BLVD SUITE 200
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City | DAYTON
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State | OH
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Zip | 45429-6401
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Country | US
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Telephone | 937-298-8058
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Fax | 937-298-5638
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3009047
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | COA.19092-NP
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License Number State | OH
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