Individual
MS. MILLICENT COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6019 WALNUT GROVE RD, MEMPHIS, TN 38120-2113
(901) 226-5000
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 261-3606
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
31935
TN
367500000X
Certified Registered Nurse Anesthetist
R759483
MS
367500000X
Certified Registered Nurse Anesthetist
SRA-100010
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03781877
—
MS
01
—
2208630
CIGNA
MS
01
—
302I432501
MEDICARE PTAN
MS
01
—
3150317
UNITED HEALTHCARE
MS
01
—
7622922
AETNA
MS
Enumeration date
04/20/2006
Last updated
09/09/2022
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