Individual
KEELY L COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1682 NE PINE ISLAND RD, CAPE CORAL, FL 33909-1756
(239) 424-1600
(239) 424-1640
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 424-1600
(239) 424-1640
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085-000551
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-000551
STATE LICENSE
IL
05
—
100264100
—
FL
Enumeration date
03/22/2007
Last updated
02/02/2022
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