Provider Demographics
NPI:1821301912
Name:COOK, INGRID GUAY (NP)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:GUAY
Last Name:COOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4103
Mailing Address - Country:US
Mailing Address - Phone:318-222-6226
Mailing Address - Fax:318-524-7252
Practice Address - Street 1:1825 N 18TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4420
Practice Address - Country:US
Practice Address - Phone:318-322-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06191363LP0200X
LAAPO6191363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA042628APNOtherCDS
LA060109OtherLOUISIANA PA#
LA2120107Medicaid
TX12290OtherRX AUTHORITY NUMBER