Provider Demographics
NPI:1255421665
Name:COOK, TERESA LYNN (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:COOK
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1963
Mailing Address - Country:US
Mailing Address - Phone:270-886-4625
Mailing Address - Fax:
Practice Address - Street 1:222 W 18TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1963
Practice Address - Country:US
Practice Address - Phone:270-886-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN103725163W00000X
TNAPN7114363L00000X
KY3011988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P24828Medicare UPIN
TN3642339Medicare ID - Type Unspecified