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General NPI Number Information
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NPI Number | 1881710903
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Entity Type | Individual
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Provider Name | MRS. JEANETTE COOK
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 104W SPRING ST
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City | MINERAL SPRINGS
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State | AR
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Zip | 71851-0104
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Country | US
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Telephone | 870-287-7346
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Fax | 870-287-4236
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Provider Business Mailing Address
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Address Line | P.O.BOX 795
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City | MINERAL SPRINGS
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State | AR
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Zip | 71851-0795
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Country | US
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Telephone | 870-287-7346
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Fax | 870-287-4236
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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