Provider Demographics
NPI:1851728240
Name:COOK, MICHELLE L (FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:1327 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4443
Practice Address - Country:US
Practice Address - Phone:903-510-8840
Practice Address - Fax:903-510-1121
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657085363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8929UKOtherBCBS
TX75-2616977-016OtherTRICARE
TXP01550188OtherRAIL ROAD
TX327166002Medicaid
TX75-2616977-021OtherTRICARE
TXP01550188OtherRAIL ROAD