Provider Demographics
NPI:1356363691
Name:COOK, VANESSA KAY (MD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:KAY
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:HALLOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56728-4215
Mailing Address - Country:US
Mailing Address - Phone:218-843-2165
Mailing Address - Fax:218-843-8879
Practice Address - Street 1:222 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502
Practice Address - Country:US
Practice Address - Phone:785-565-2900
Practice Address - Fax:785-565-2952
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN70416207Q00000X
KS04-31292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200331440FMedicaid
IA1699976696Medicaid