Provider Demographics
NPI:1700391281
Name:COOK, BRANDY LA-KEYSHA (FNP)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:LA-KEYSHA
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3394 MCKELVEY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2531
Mailing Address - Country:US
Mailing Address - Phone:314-707-4582
Mailing Address - Fax:
Practice Address - Street 1:3394 MCKELVEY RD STE 102
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2531
Practice Address - Country:US
Practice Address - Phone:314-707-4592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF04170189163WG0000X
MO2017014616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice