Provider Demographics
NPI:1407881618
Name:COOK, BRIANNE J (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BRIANNE
Middle Name:J
Last Name:COOK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BRIANNE
Other - Middle Name:J
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3425
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-0425
Mailing Address - Country:US
Mailing Address - Phone:785-830-0100
Mailing Address - Fax:785-830-0115
Practice Address - Street 1:4921 W 18TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2090
Practice Address - Country:US
Practice Address - Phone:785-830-0100
Practice Address - Fax:785-830-0115
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01017363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG24067Medicare UPIN
KS426841Medicare ID - Type Unspecified