Provider Demographics
NPI:1316141104
Name:COOKE, JUDITH L (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:L
Last Name:COOKE
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 1:2075 DEATSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COXS CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40013-7428
Mailing Address - Country:US
Mailing Address - Phone:502-348-7448
Mailing Address - Fax:502-349-6241
Practice Address - Street 1:2075 DEATSVILLE RD
Practice Address - Street 2:
Practice Address - City:COXS CREEK
Practice Address - State:KY
Practice Address - Zip Code:40013-7428
Practice Address - Country:US
Practice Address - Phone:502-348-7448
Practice Address - Fax:502-349-6241
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYF02916Medicare UPIN