Provider Demographics
NPI:1760437404
Name:COOK, ANGELA K (DNP)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:K
Last Name:COOK
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 W. BRIERBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:662-470-1921
Mailing Address - Fax:901-624-6521
Practice Address - Street 1:146 TIMBER CREEK DR STE 200
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4474
Practice Address - Country:US
Practice Address - Phone:901-751-4112
Practice Address - Fax:901-751-9878
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-11-05
Deactivation Date:2019-08-01
Deactivation Code:
Reactivation Date:2019-10-31
Provider Licenses
StateLicense IDTaxonomies
MSR858017363LF0000X
FL9390423363LF0000X
TN13922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02786077Medicaid
MSQ29684Medicare UPIN