Doctor Name: | KELLY COOK |
NPI Number: | 1053713867 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RT,CT,RDMS |
License Number: | 59296 |
Business Practice Address: | 706 W Grove St El Dorado, AR - 717304416 |
Business Phone Number: | 8703101757 |
Business Fax Number: | |
Mailing Address: | 4014 Calion Hwy, EL DORADO |
State: | AR |
Postal Code: | 717309447 |
Phone Number: | 8703101757 |
Fax Number: | |
NPI Enumeration Date: | 09/23/2014 |
NPI Last Update Date: | 09/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2471S1302X |
License Number: | 59296 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Radiologic Technologist |
Taxonomy Specialization: | Sonography |
Taxonomy Definition: |