Provider Demographics
NPI:1407741804
Name:COOK, SHELLY ELAINE (CNA)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:ELAINE
Last Name:COOK
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11644 OLD HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-9722
Mailing Address - Country:US
Mailing Address - Phone:769-372-5961
Mailing Address - Fax:
Practice Address - Street 1:11644 OLD HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-9722
Practice Address - Country:US
Practice Address - Phone:769-372-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10087102376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide