MEDICARE: SHANNON LYNN COOK DNP, FNP-C

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	19485.0344	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19485344	OTHER	WY	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	6145LC05M	OTHER	WY	SUBSTANCE CONTROL

General Provider Information

NPI Number	:	1952384927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON LYNN COOK DNP, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 20970
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82003-7020
Country	:	US
Telephone Number	:	307-996-1560
Fax Number	:	307-996-1565

Provider Business Practice Location Address
First Line	:	800 E 20TH ST
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-3859
Country	:	US
Telephone Number	:	307-633-7444
Fax Number	:

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	11/15/2022

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