Provider Demographics
NPI:1891702759
Name:COOK, BETHANY J (APRN-WHNP)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:J
Last Name:COOK
Suffix:
Gender:F
Credentials:APRN-WHNP
Other - Prefix:MRS
Other - First Name:BETHANY
Other - Middle Name:J
Other - Last Name:MEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP, CNM
Mailing Address - Street 1:9800 BROADWAY EXT STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-6304
Mailing Address - Country:US
Mailing Address - Phone:405-715-4496
Mailing Address - Fax:405-715-4499
Practice Address - Street 1:9800 BROADWAY EXT STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6304
Practice Address - Country:US
Practice Address - Phone:405-715-4496
Practice Address - Fax:405-715-4499
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK110750363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190266002Medicaid
TX8L21409Medicare PIN