Provider Demographics
NPI:1922653971
Name:COOK, HEATHER (PAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 W 9000 S STE 110
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8870
Mailing Address - Country:US
Mailing Address - Phone:208-201-1249
Mailing Address - Fax:
Practice Address - Street 1:3570 W 9000 S STE 110
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8870
Practice Address - Country:US
Practice Address - Phone:208-201-1249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant