Provider Demographics
NPI:1932717576
Name:RACHAL COOKE, TERA (AGNP)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:
Last Name:RACHAL COOKE
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 MISSILE BASE RD
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078-8328
Mailing Address - Country:US
Mailing Address - Phone:318-208-1191
Mailing Address - Fax:
Practice Address - Street 1:1712 MISSILE BASE RD
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078-8328
Practice Address - Country:US
Practice Address - Phone:318-775-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA214421363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health