Provider Demographics
NPI:1356424634
Name:COOK, BARBARA LYNN (PA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:LYNN
Last Name:COOK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950 N MERIDIAN STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-3908
Mailing Address - Country:US
Mailing Address - Phone:317-962-4940
Mailing Address - Fax:317-962-4950
Practice Address - Street 1:9202 E 116TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-2830
Practice Address - Country:US
Practice Address - Phone:317-594-1300
Practice Address - Fax:317-594-1310
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10000392363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS99014Medicare UPIN
970014555Medicare PIN
970014407Medicare PIN
INM400020861Medicare PIN
IN151550DMedicare PIN
970014431Medicare PIN