Provider Demographics
NPI:1275800799
Name:COOK, KASEY (PA-C)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
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 1:2600 6TH ST SW
Mailing Address - Street 2:SUITE A2-710
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1702
Mailing Address - Country:US
Mailing Address - Phone:330-454-8076
Mailing Address - Fax:330-454-3927
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:SUITE A2-710
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-454-8076
Practice Address - Fax:330-454-3927
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-003410363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant