Provider Demographics
NPI:1639881485
Name:COOK, EMILY KATHERINE (APRN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHERINE
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 1:405 CRAWFORD ST APT 2219
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-1387
Mailing Address - Country:US
Mailing Address - Phone:817-360-3282
Mailing Address - Fax:
Practice Address - Street 1:405 CRAWFORD ST APT 2219
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1387
Practice Address - Country:US
Practice Address - Phone:817-360-3282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1101431363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health