Provider Demographics
NPI:1891420303
Name:COOK, BRANDEE NIKOLE
Entity Type:Individual
Prefix:
First Name:BRANDEE
Middle Name:NIKOLE
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7389 KEENEY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTONE
Mailing Address - State:WV
Mailing Address - Zip Code:25985-9292
Mailing Address - Country:US
Mailing Address - Phone:304-660-5758
Mailing Address - Fax:
Practice Address - Street 1:7389 KEENEY MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:WV
Practice Address - Zip Code:25985-9292
Practice Address - Country:US
Practice Address - Phone:304-660-5758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant