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1720478548

NPI Code Detail

MEDICARE: RYAN S COOK APRN

MEDICARE: RYAN S COOK APRN

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	3009047	KY
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.19092	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000916710	OTHER	KY	ANTHEM-NICC
2	171432	OTHER	KY	SIHO-NICC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720478548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN S COOK APRN

Provider Business Mailing Address
First Line	:	3000 MACK RD STE 100
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-5335
Country	:	US
Telephone Number	:	513-751-4222
Fax Number	:	513-874-3023

Provider Business Practice Location Address
First Line	:	3000 MACK RD STE 100
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-5335
Country	:	US
Telephone Number	:	513-751-4222
Fax Number	:	513-874-3023

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

Provider Enumeration Date	:	02/01/2015
Last Update Date	:	02/23/2026

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Directions to “ RYAN S COOK APRN” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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