Provider Demographics
NPI:1447217955
Name:COOK, GAIL RAE (PA)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:RAE
Last Name:COOK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:FAMILY HEALTH SERVICES CORPORATION
Mailing Address - Street 2:325 MARTIN ST
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4536
Mailing Address - Country:US
Mailing Address - Phone:208-734-0451
Mailing Address - Fax:208-734-0452
Practice Address - Street 1:325 MARTIN ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4563
Practice Address - Country:US
Practice Address - Phone:208-734-0451
Practice Address - Fax:208-734-0452
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-480363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ04824Medicare UPIN