Provider Demographics
NPI:1790326353
Name:COOKE, THEIL L JR (APRN)
Entity Type:Individual
Prefix:
First Name:THEIL
Middle Name:L
Last Name:COOKE
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:340 W HARKER AVE # 750
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86021-6198
Mailing Address - Country:US
Mailing Address - Phone:928-377-0629
Mailing Address - Fax:435-216-5969
Practice Address - Street 1:1070 N HILDALE ST # 750
Practice Address - Street 2:
Practice Address - City:HILDALE
Practice Address - State:UT
Practice Address - Zip Code:84784-7770
Practice Address - Country:US
Practice Address - Phone:352-165-4884
Practice Address - Fax:435-216-5969
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ233616363LF0000X
UT8273152-8900363LF0000X
AZRN178632163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency