Provider Demographics
NPI:1912013426
Name:COOKE, VICKY LEIGH (ANP-C)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:LEIGH
Last Name:COOKE
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 EXECUTIVE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-7911
Mailing Address - Country:US
Mailing Address - Phone:423-287-5720
Mailing Address - Fax:423-633-1880
Practice Address - Street 1:1017 EXECUTIVE DR STE 101
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7911
Practice Address - Country:US
Practice Address - Phone:423-287-5720
Practice Address - Fax:423-633-1880
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN1300077363L00000X
TN8150363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ090873Medicaid
TN3902922Medicaid
TN4090393OtherBCBS
TN3902922Medicaid