Provider Demographics
NPI:1568626174
Name:COOK, LEONA FAYE
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:FAYE
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 N MILDRED ST
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-5552
Mailing Address - Country:US
Mailing Address - Phone:304-724-6091
Mailing Address - Fax:304-725-7204
Practice Address - Street 1:1212 N MILDRED ST
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-5552
Practice Address - Country:US
Practice Address - Phone:304-724-6091
Practice Address - Fax:304-725-7204
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily