Provider Demographics
NPI:1649091877
Name:COOK, KHALIAH SHILEEN (RN)
Entity type:Individual
Prefix:
First Name:KHALIAH
Middle Name:SHILEEN
Last Name:COOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:FLORA
Other - Middle Name:KAYYS
Other - Last Name:HOME LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:308 WEST JOSIE LANE
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037
Mailing Address - Country:US
Mailing Address - Phone:318-286-2043
Mailing Address - Fax:
Practice Address - Street 1:308 WEST JOSIE LANE
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037
Practice Address - Country:US
Practice Address - Phone:318-286-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211129163WA2000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty