Provider Demographics
NPI:1215534904
Name:COOK, MESHELL DENICE (LPN)
Entity Type:Individual
Prefix:
First Name:MESHELL
Middle Name:DENICE
Last Name:COOK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 HUNTINGTON CHASE CT
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2659
Mailing Address - Country:US
Mailing Address - Phone:478-714-5790
Mailing Address - Fax:
Practice Address - Street 1:6132 HAWKINSVILLE RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-5848
Practice Address - Country:US
Practice Address - Phone:478-788-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN087920164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse