Provider Demographics
NPI:1619503869
Name:COOK, CINDY DIAN (APRN)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:DIAN
Last Name:COOK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:AMITY
Mailing Address - State:AR
Mailing Address - Zip Code:71921-0218
Mailing Address - Country:US
Mailing Address - Phone:870-342-5606
Mailing Address - Fax:870-342-5802
Practice Address - Street 1:210 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AMITY
Practice Address - State:AR
Practice Address - Zip Code:71921-9733
Practice Address - Country:US
Practice Address - Phone:870-342-5606
Practice Address - Fax:870-342-5802
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily