Provider Demographics
NPI:1053012781
Name:COOK, CHASTITY
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9916 VILLA VERDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-4410
Mailing Address - Country:US
Mailing Address - Phone:682-299-5901
Mailing Address - Fax:
Practice Address - Street 1:9916 VILLA VERDE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-4410
Practice Address - Country:US
Practice Address - Phone:682-299-5901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty