Provider Demographics
NPI:1588130835
Name:COOK, KARRIE ANN (NP)
Entity type:Individual
Prefix:
First Name:KARRIE
Middle Name:ANN
Last Name:COOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KARRIE
Other - Middle Name:ANN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2331 HUALAPAI MOUNTAIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-6207
Mailing Address - Country:US
Mailing Address - Phone:928-565-6655
Mailing Address - Fax:928-565-6578
Practice Address - Street 1:2331 HUALAPAI MOUNTAIN RD STE C
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-6207
Practice Address - Country:US
Practice Address - Phone:928-565-6655
Practice Address - Fax:928-565-6578
Is Sole Proprietor?:No
Enumeration Date:2018-10-14
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF03180810363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily