Provider Demographics
NPI:1598373086
Name:COOK, KATHERINE RENEE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RENEE
Last Name:COOK
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:901 SW 33RD PL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-8507
Mailing Address - Country:US
Mailing Address - Phone:561-706-9334
Mailing Address - Fax:
Practice Address - Street 1:901 SW 33RD PL
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-8507
Practice Address - Country:US
Practice Address - Phone:561-706-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant