Provider Demographics
NPI:1114494366
Name:COOK, STEVEN C (NP-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:C
Last Name:COOK
Suffix:
Gender:M
Credentials:NP-C
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 277381
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 CHANNING WAY STE 206
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7546
Practice Address - Country:US
Practice Address - Phone:208-529-2230
Practice Address - Fax:208-453-6142
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID59836363LF0000X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID59836OtherIDAHO BOARD OF NURSING APRN LICENSE
ID43381OtherIDAHO BOARD OF NURSING, NURSING LISCENSE
IDF09180055OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION NO.