Provider Demographics
NPI:1225924400
Name:COOK, MANDY M
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:M
Last Name:COOK
Suffix:
Gender:X
Credentials:
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 32
Mailing Address - Street 2:
Mailing Address - City:ACCOVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25606-0032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 FESTIVE DR
Practice Address - Street 2:
Practice Address - City:ACCOVILLE
Practice Address - State:WV
Practice Address - Zip Code:25606
Practice Address - Country:US
Practice Address - Phone:304-583-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide