Provider Demographics
NPI:1538581707
Name:COOK, MELISSA K (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:K
Last Name:COOK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2004
Mailing Address - Country:US
Mailing Address - Phone:405-755-4050
Mailing Address - Fax:405-749-9566
Practice Address - Street 1:5201 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2004
Practice Address - Country:US
Practice Address - Phone:405-755-4050
Practice Address - Fax:405-749-9566
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA2340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant