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General NPI Number Information
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NPI Number | 1841035847
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Entity Type | Individual
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Provider Name | KAYLEY W COOK BSN
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Gender | Female
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Dates
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Enumeration Date | 07/01/2024
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 2854 NW RALEIGH ST
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City | PORTLAND
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State | OR
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Zip | 97210-2465
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Country | US
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Telephone | 503-799-9660
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Fax |
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Provider Business Mailing Address
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Address Line | 3455 SW US VETERANS HOSPITAL RD
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City | PORTLAND
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State | OR
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Zip | 97239-3076
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Country | US
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Telephone | 503-799-9660
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 095000331RN
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License Number State | OR
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