Provider Demographics
NPI:1407399512
Name:COOK, KELSEY (RN)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 S WESTERN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6589
Mailing Address - Country:US
Mailing Address - Phone:605-334-4337
Mailing Address - Fax:
Practice Address - Street 1:3801 S WESTERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6589
Practice Address - Country:US
Practice Address - Phone:605-334-4337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR045733163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse