Provider Demographics
NPI:1952080525
Name:COOK, MCKENZY KATE (DNP)
Entity Type:Individual
Prefix:MRS
First Name:MCKENZY
Middle Name:KATE
Last Name:COOK
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 VILLAGE GREEN DRIVE W LOOP
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5340
Mailing Address - Country:US
Mailing Address - Phone:218-988-2196
Mailing Address - Fax:
Practice Address - Street 1:435 32ND AVE E STE B
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-2894
Practice Address - Country:US
Practice Address - Phone:701-205-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR44702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine