Provider Demographics
NPI:1831602341
Name:COOK, DESIREE DAWN (CPNP-PC, PMHNP)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:DAWN
Last Name:COOK
Suffix:
Gender:F
Credentials:CPNP-PC, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 E MERIDIAN PARK LOOP STE 200
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7242
Mailing Address - Country:US
Mailing Address - Phone:907-357-4400
Mailing Address - Fax:
Practice Address - Street 1:3750 E. COUNTRY FIELD CIRCLE
Practice Address - Street 2:SUITE C
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-357-2955
Practice Address - Fax:907-357-9348
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK126978363LP0200X
AK2023001598363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health