Provider Demographics
NPI:1407916943
Name:COOK, PAMALA LYNN (CNM)
Entity Type:Individual
Prefix:
First Name:PAMALA
Middle Name:LYNN
Last Name:COOK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 N MOUND ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4027
Mailing Address - Country:US
Mailing Address - Phone:936-568-8425
Mailing Address - Fax:
Practice Address - Street 1:1108 SOUTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-5986
Practice Address - Country:US
Practice Address - Phone:936-560-3097
Practice Address - Fax:936-462-8495
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237750367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037033004Medicaid
TX8B5507Medicare ID - Type Unspecified
TX037033004Medicaid