Basic Information
| Provider Information | |||||||||
| NPI: | 1255362794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COOK-SMITH | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2021 WINTON RD S | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146183957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857846400 | ||||||||
| FaxNumber: | 5853412370 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 PORTLAND AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5856976416 | ||||||||
| FaxNumber: | 5854443280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 01/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 333782 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 02565204 | 05 | NY | MEDICAID |