Provider Demographics
NPI:1336627223
Name:COOK, THOMAS TEDFORD (APRN)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:TEDFORD
Last Name:COOK
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 N PORTLAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1650
Mailing Address - Country:US
Mailing Address - Phone:405-942-5513
Mailing Address - Fax:
Practice Address - Street 1:5700 N PORTLAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1650
Practice Address - Country:US
Practice Address - Phone:405-942-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR102398363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care