Provider Demographics
NPI:1881710903
Name:COOK, JEANETTE
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 795
Mailing Address - Street 2:
Mailing Address - City:MINERAL SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71851-0795
Mailing Address - Country:US
Mailing Address - Phone:870-287-7346
Mailing Address - Fax:870-287-4236
Practice Address - Street 1:104W SPRING ST
Practice Address - Street 2:
Practice Address - City:MINERAL SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71851-0104
Practice Address - Country:US
Practice Address - Phone:870-287-7346
Practice Address - Fax:870-287-4236
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator