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 1:1740 COMBE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5094
Mailing Address - Country:US
Mailing Address - Phone:801-621-1701
Mailing Address - Fax:
Practice Address - Street 1:1740 COMBE RD STE 5
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5094
Practice Address - Country:US
Practice Address - Phone:801-621-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7029901-1204208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics