Provider Demographics
NPI:1568465136
Name:COOK PORTER, KATHY ADRIANNE (NP)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ADRIANNE
Last Name:COOK PORTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:C
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3450 W WHEATLAND RD STE 440
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4417
Mailing Address - Country:US
Mailing Address - Phone:972-298-4300
Mailing Address - Fax:972-298-8903
Practice Address - Street 1:3450 W WHEATLAND RD STE 440
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-4417
Practice Address - Country:US
Practice Address - Phone:972-298-4300
Practice Address - Fax:972-298-8903
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111291363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1479685Medicaid
TX1479685Medicaid
TXNP0304Medicare ID - Type Unspecified