Provider Demographics
NPI:1881632057
Name:COOK, PATRICIA (ARNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:ARNP
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 47222
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7222
Mailing Address - Country:US
Mailing Address - Phone:316-268-8131
Mailing Address - Fax:316-291-4788
Practice Address - Street 1:3600 E HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3713
Practice Address - Country:US
Practice Address - Phone:316-268-5775
Practice Address - Fax:316-291-7496
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-30835-031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200004870BMedicaid
KS161179Medicare ID - Type Unspecified