Provider Demographics
NPI:1588433692
Name:COOK, KALEY ELIZABETH (PMHNP)
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:ELIZABETH
Last Name:COOK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 SFC 852
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:AR
Mailing Address - Zip Code:72372-8548
Mailing Address - Country:US
Mailing Address - Phone:870-589-3636
Mailing Address - Fax:
Practice Address - Street 1:4360 SHORE DR STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2994
Practice Address - Country:US
Practice Address - Phone:757-251-0879
Practice Address - Fax:984-220-9437
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR224840363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health