Provider Demographics
NPI:1699216192
Name:COOK-MOBLEY, TAMELA (APRN)
Entity Type:Individual
Prefix:
First Name:TAMELA
Middle Name:
Last Name:COOK-MOBLEY
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 1:310 S ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:GOLDENDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98620-9201
Mailing Address - Country:US
Mailing Address - Phone:509-773-4022
Mailing Address - Fax:509-773-1941
Practice Address - Street 1:317 SANDERS WAY
Practice Address - Street 2:
Practice Address - City:GOLDENDALE
Practice Address - State:WA
Practice Address - Zip Code:98620-9059
Practice Address - Country:US
Practice Address - Phone:509-773-1407
Practice Address - Fax:509-773-4543
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027402363LF0000X
KY3011065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1129681OtherRN LICENSE NUMBER
KY3011065OtherAPRN LICENSE NUMBER