Provider Demographics
NPI:1093173247
Name:COOK, PATRICE ANN (REEGT)
Entity Type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:ANN
Last Name:COOK
Suffix:
Gender:F
Credentials:REEGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 893076
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189
Mailing Address - Country:US
Mailing Address - Phone:405-769-7241
Mailing Address - Fax:405-769-7241
Practice Address - Street 1:7700 N. HUDSON AVE
Practice Address - Street 2:SUITE NUMBER 9
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:405-769-7241
Practice Address - Fax:405-769-7241
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3375246ZE0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG