MEDICARE: INGRID GUAY 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	363LP0200X	Pediatric Nurse Practitioner	AP06191	LA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APO6191	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042628APN	OTHER	LA	CDS
2	060109	OTHER	LA	LOUISIANA PA#
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	12290	OTHER	TX	RX AUTHORITY NUMBER

General Provider Information

NPI Number	:	1821301912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID GUAY COOK NP

Provider Business Mailing Address
First Line	:	1006 HIGHLAND AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4103
Country	:	US
Telephone Number	:	318-222-6226
Fax Number	:	318-524-7252

Provider Business Practice Location Address
First Line	:	1825 N 18TH ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-4420
Country	:	US
Telephone Number	:	318-322-7999
Fax Number	:

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

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	06/02/2021

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