Basic Information
| Provider Information | |||||||||
| NPI: | 1972596344 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | GAIL | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | WHITESBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 418587627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066333631 | ||||||||
| FaxNumber: | 6066336204 | ||||||||
| Practice Location | |||||||||
| Address1: | 214 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | WHITESBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 418587627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066333631 | ||||||||
| FaxNumber: | 6066336204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 02/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3002342 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 78002466 | 05 | KY | MEDICAID |