Provider Demographics
NPI:1104809987
Name:COOK, JENIFER P (MD)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:P
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGOTON
Mailing Address - State:KS
Mailing Address - Zip Code:67951-2858
Mailing Address - Country:US
Mailing Address - Phone:620-544-6186
Mailing Address - Fax:620-544-4076
Practice Address - Street 1:1006 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGOTON
Practice Address - State:KS
Practice Address - Zip Code:67951-2858
Practice Address - Country:US
Practice Address - Phone:620-544-6186
Practice Address - Fax:620-544-4076
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS004-28272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS501910Other1ST GUARD
KS200307700AMedicaid