MEDICARE: KARRIE ANN COOK NP

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	363LF0000X	Family Nurse Practitioner	F03180810	AZ

General Provider Information

NPI Number	:	1588130835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARRIE ANN COOK NP

Provider Business Mailing Address
First Line	:	2331 HUALAPAI MOUNTAIN RD STE C
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-6207
Country	:	US
Telephone Number	:	928-565-6655
Fax Number	:	928-565-6578

Provider Business Practice Location Address
First Line	:	2331 HUALAPAI MOUNTAIN RD STE C
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-6207
Country	:	US
Telephone Number	:	928-565-6655
Fax Number	:	928-565-6578

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

Provider Enumeration Date	:	10/14/2018
Last Update Date	:	08/22/2019

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