Provider Demographics
NPI:1750846424
Name:COOK, SAMANTHA D (NP-C)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:D
Last Name:COOK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11553 US HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:STOUT
Mailing Address - State:OH
Mailing Address - Zip Code:45684-9649
Mailing Address - Country:US
Mailing Address - Phone:740-285-2279
Mailing Address - Fax:220-666-0507
Practice Address - Street 1:230 CHERRY ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2301
Practice Address - Country:US
Practice Address - Phone:220-666-0507
Practice Address - Fax:220-666-0507
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH024145363L00000X
KY3013129363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH024145Medicaid
KY3013129Medicaid