Provider Demographics
NPI:1487025680
Name:COOK, KIM (CPNP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 SAN PEDRO AVE
Mailing Address - Street 2:STE 412
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4361
Mailing Address - Country:US
Mailing Address - Phone:210-281-8669
Mailing Address - Fax:
Practice Address - Street 1:17323 IH 35 N
Practice Address - Street 2:STE 113
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1277
Practice Address - Country:US
Practice Address - Phone:210-543-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129341363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics