Provider Demographics
NPI:1548827066
Name:COOK, MELONIE ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:MELONIE
Middle Name:ANN
Last Name:COOK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:MELONIE
Other - Middle Name:ANN
Other - Last Name:HORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1407 JENNIFER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-2091
Mailing Address - Country:US
Mailing Address - Phone:479-466-9611
Mailing Address - Fax:
Practice Address - Street 1:1407 JENNIFER ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-2091
Practice Address - Country:US
Practice Address - Phone:479-466-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005489363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology