Provider Demographics
NPI:1336426378
Name:COOK, PAT
Entity Type:Individual
Prefix:
First Name:PAT
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 NBU
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-7508
Mailing Address - Country:US
Mailing Address - Phone:405-567-2280
Mailing Address - Fax:405-567-2280
Practice Address - Street 1:719 S JIM THORPE BLVD
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864-3505
Practice Address - Country:US
Practice Address - Phone:405-567-2280
Practice Address - Fax:405-567-2280
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator