Provider Demographics
NPI:1821518952
Name:COOKSEY, BRIAN J
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:COOKSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 CORDELIA DR
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-5300
Mailing Address - Country:US
Mailing Address - Phone:209-777-9625
Mailing Address - Fax:
Practice Address - Street 1:1903 CORDELIA DR
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-5300
Practice Address - Country:US
Practice Address - Phone:209-777-9625
Practice Address - Fax:209-777-9625
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)