Provider Demographics
NPI:1699118414
Name:COOK, ALLISON DANAE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:DANAE
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 1:1720 NICHOLASVILLE RD STE 702
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1489
Mailing Address - Country:US
Mailing Address - Phone:859-264-8811
Mailing Address - Fax:859-264-8822
Practice Address - Street 1:1720 NICHOLASVILLE RD STE 702
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1489
Practice Address - Country:US
Practice Address - Phone:859-264-8811
Practice Address - Fax:859-264-8822
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY50291207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100469920Medicaid