Provider Demographics
NPI:1912205931
Name:COOKSEY, GLADYS (RN, NPF)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:COOKSEY
Suffix:
Gender:F
Credentials:RN, NPF
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 3768
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3768
Mailing Address - Country:US
Mailing Address - Phone:209-725-7149
Mailing Address - Fax:209-726-0134
Practice Address - Street 1:1675 BELLEVUE RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-2608
Practice Address - Country:US
Practice Address - Phone:209-725-7149
Practice Address - Fax:209-726-0134
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5077363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner