Provider Demographics
NPI:1033952205
Name:COOK, BRANDY MICHELLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:MICHELLE
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 S COUNTY ROAD 225 E
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:IN
Mailing Address - Zip Code:47598-8812
Mailing Address - Country:US
Mailing Address - Phone:317-402-0474
Mailing Address - Fax:
Practice Address - Street 1:1701 SPRING ST STE B
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-2930
Practice Address - Country:US
Practice Address - Phone:812-284-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015398A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily