Provider Demographics
NPI:1891013249
Name:JEANNIE COOK PC
Entity Type:Organization
Organization Name:JEANNIE COOK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHEA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:214-649-6932
Mailing Address - Street 1:5700 TENNYSON PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3595
Mailing Address - Country:US
Mailing Address - Phone:214-649-6932
Mailing Address - Fax:
Practice Address - Street 1:5700 TENNYSON PKWY STE 300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3595
Practice Address - Country:US
Practice Address - Phone:214-649-6932
Practice Address - Fax:214-387-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX588731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K1224Medicare PIN