Provider Demographics
NPI:1285698555
Name:TERRILL COOKE, JACQUALINE M (CNM FNP)
Entity type:Individual
Prefix:MRS
First Name:JACQUALINE
Middle Name:M
Last Name:TERRILL COOKE
Suffix:
Gender:F
Credentials:CNM FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:320 SE BAKER ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6038
Mailing Address - Country:US
Mailing Address - Phone:503-474-3600
Mailing Address - Fax:503-474-3601
Practice Address - Street 1:320 SE BAKER ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6038
Practice Address - Country:US
Practice Address - Phone:503-474-3600
Practice Address - Fax:503-474-3601
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200040704RN163WG0000X
OR200350072NPFNPPP363LF0000X
OR200450066NP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR233427Medicaid
ORQ72188Medicare UPIN