Basic Information
| Provider Information | |||||||||
| NPI: | 1265919708 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64 LETTA DR | ||||||||
| Address2: | |||||||||
| City: | POTTSVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 728585000 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 291 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LAMAR | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708952015 | ||||||||
| FaxNumber: | 8708952164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2018 | ||||||||
| LastUpdateDate: | 06/24/2019 | ||||||||
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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 | A005788 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.