Provider Demographics
NPI:1073152906
Name:COOK, ELIZABETH RITA (APRN, DNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RITA
Last Name:COOK
Suffix:
Gender:F
Credentials:APRN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 MASSIE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2125
Mailing Address - Country:US
Mailing Address - Phone:502-428-6230
Mailing Address - Fax:
Practice Address - Street 1:6440 DUTCHMANS PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3352
Practice Address - Country:US
Practice Address - Phone:502-896-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014103363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health