Provider Demographics
NPI:1265244370
Name:COOK, KIMBRA KAY (LPN)
Entity type:Individual
Prefix:
First Name:KIMBRA
Middle Name:KAY
Last Name:COOK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 C AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402
Mailing Address - Country:US
Mailing Address - Phone:319-743-5187
Mailing Address - Fax:
Practice Address - Street 1:8900 C AVENUE NORTHEAST
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-200-3850
Practice Address - Fax:319-200-3866
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP46619164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse