Provider Demographics
NPI:1922715705
Name:COOK, MORGAN LORRAINE (PMHNP)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:LORRAINE
Last Name:COOK
Suffix:
Gender:F
Credentials:PMHNP
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 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:208-215-2005
Mailing Address - Fax:
Practice Address - Street 1:1038 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2249
Practice Address - Country:US
Practice Address - Phone:208-620-5210
Practice Address - Fax:844-803-7399
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID53333363L00000X, 363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1922715705Medicaid