Provider Demographics
NPI:1720478548
Name:COOK, RYAN S (APRN)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:S
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 1:540 LINCOLN PARK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-6401
Mailing Address - Country:US
Mailing Address - Phone:937-298-8058
Mailing Address - Fax:937-298-5638
Practice Address - Street 1:540 LINCOLN PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-6401
Practice Address - Country:US
Practice Address - Phone:937-298-8058
Practice Address - Fax:937-298-5638
Is Sole Proprietor?:No
Enumeration Date:2015-02-01
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009047363LF0000X
OHCOA.19092-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000916710OtherANTHEM-NICC
KY171432OtherSIHO-NICC
KY7100338960Medicaid
KY7100338960Medicaid
KYK189340Medicare PIN