Provider Demographics
NPI:1053177691
Name:COOK, ANGEL M (FNP-BC)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:M
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 ANTOINETTE WAY
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-7407
Mailing Address - Country:US
Mailing Address - Phone:513-967-6159
Mailing Address - Fax:
Practice Address - Street 1:2342 ANTOINETTE WAY
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-7407
Practice Address - Country:US
Practice Address - Phone:513-967-6159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1132387163W00000X
KY4016628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse