MEDICARE: MR. RAY ROBERT COOK III

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	171400000X	Health & Wellness Coach	A-4208768	WA
2	133NN1002X	Nutrition Education Nutritionist		WA

General Provider Information

NPI Number	:	1720887003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAY ROBERT COOK III

Provider Business Mailing Address
First Line	:	14125 SR 530 NE
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-9335
Country	:	US
Telephone Number	:	425-577-1502
Fax Number	:

Provider Business Practice Location Address
First Line	:	14125 SR 530 NE
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-9335
Country	:	US
Telephone Number	:	425-577-1502
Fax Number	:

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

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	04/06/2026

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Directions to “ MR. RAY ROBERT COOK III ” Practice Location

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