Provider Demographics
NPI:1699519413
Name:COOKS, TANESHA NICOLE
Entity type:Individual
Prefix:
First Name:TANESHA
Middle Name:NICOLE
Last Name:COOKS
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 1:7921 NW 21ST ST APT G47921NW
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-5354
Mailing Address - Country:US
Mailing Address - Phone:405-408-7325
Mailing Address - Fax:
Practice Address - Street 1:7921 NW 21ST ST APT G47921
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-5354
Practice Address - Country:US
Practice Address - Phone:405-408-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator