Provider Demographics
NPI:1275609141
Name:COOK, NEOMA LOU (LVN)
Entity Type:Individual
Prefix:MRS
First Name:NEOMA
Middle Name:LOU
Last Name:COOK
Suffix:
Gender:F
Credentials:LVN
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 1326
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-5326
Mailing Address - Country:US
Mailing Address - Phone:254-547-8817
Mailing Address - Fax:254-618-8099
Practice Address - Street 1:31ST STAND BATTALION
Practice Address - Street 2:BENNETT HEALTH CLINIC BLD 420
Practice Address - City:FT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-618-8040
Practice Address - Fax:254-618-8099
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133188164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse