Provider Demographics
NPI:1912585738
Name:COOK, KASEY SCOTT (DO)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:SCOTT
Last Name:COOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 LOCUST ST N STE 700
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4164
Mailing Address - Country:US
Mailing Address - Phone:208-595-5095
Mailing Address - Fax:
Practice Address - Street 1:1502 LOCUST ST N STE 700
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4164
Practice Address - Country:US
Practice Address - Phone:208-595-5095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7029901-1204208000000X
ID7771767208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics