Provider Demographics
NPI:1679556336
Name:COOK, CARA P (FNP)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:P
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 GALLERIA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4625
Mailing Address - Country:US
Mailing Address - Phone:903-791-9120
Mailing Address - Fax:903-791-9132
Practice Address - Street 1:2101 GALLERIA OAKS DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4625
Practice Address - Country:US
Practice Address - Phone:903-791-9120
Practice Address - Fax:903-791-9132
Is Sole Proprietor?:No
Enumeration Date:2005-11-26
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX702670363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161109702Medicaid
8L12391Medicare PIN
TX161109702Medicaid