Provider Demographics
NPI:1144496985
Name:COOKE, CAROL A (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:COOKE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6438 WILMINGTON PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-7021
Mailing Address - Country:US
Mailing Address - Phone:937-848-4850
Mailing Address - Fax:937-848-4858
Practice Address - Street 1:6438 WILMINGTON PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-848-4850
Practice Address - Fax:937-848-4858
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN212344207V00000X
OHCOA05642NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRX05642OtherCERTIFICATE TO PRESCRIBE
OH0074036Medicaid
OHCOA05642NPOtherLICENSE NP
OH0074036Medicaid