Provider Demographics
NPI:1083813604
Name:COOK, YOLANDA
Entity Type:Individual
Prefix:
First Name:YOLANDA
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 1:3200 2ND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8922
Mailing Address - Country:US
Mailing Address - Phone:337-480-9757
Mailing Address - Fax:337-562-1374
Practice Address - Street 1:3200 2ND AVE STE B
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8922
Practice Address - Country:US
Practice Address - Phone:337-480-9757
Practice Address - Fax:337-562-1374
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 68663747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1004791Medicaid