MEDICARE: THELMA R COOK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1-161824	AL

General Provider Information

NPI Number	:	1073074415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THELMA R COOK

Provider Business Mailing Address
First Line	:	5222 OAKS OF ST CLAIR CIR
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004-3261
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5222 OAKS OF ST CLAIR CIR
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004-3261
Country	:	US
Telephone Number	:	256-689-6304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	03/28/2019

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Directions to “ THELMA R COOK ” Practice Location

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