Provider Demographics
NPI:1316794613
Name:COOK, TIFFANY
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MCCUTCHEN RD APT 4-206
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2661
Mailing Address - Country:US
Mailing Address - Phone:443-881-3746
Mailing Address - Fax:
Practice Address - Street 1:1101 MCCUTCHEN RD APT 4-206
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2661
Practice Address - Country:US
Practice Address - Phone:443-881-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant