=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801733415
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDY COOKSEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2026
-----------------------------------------------------
Last Update Date | 05/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 974 N 21ST ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43055-2990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-510-4357
-----------------------------------------------------
Fax | 866-460-2997
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4600 MONTGOMERY RD STE 400
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45212-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-510-4357
-----------------------------------------------------
Fax | 866-460-2997
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | LPN.107610.MEDS
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------