Provider Demographics
NPI:1225761471
Name:CROOK, DANIEL K (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:K
Last Name:CROOK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 PORT ARTHUR TER
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4643
Mailing Address - Country:US
Mailing Address - Phone:337-404-4075
Mailing Address - Fax:337-446-2548
Practice Address - Street 1:1106 PORT ARTHUR TER
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4643
Practice Address - Country:US
Practice Address - Phone:337-404-4075
Practice Address - Fax:337-446-2548
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10331363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPA.A10331OtherLOUISIANA STATE BOARD OF MEDICAL EXAMINERS