Individual
TONY D COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
308 S CHURCH ST, FAYETTE, MO 65248-1243
(660) 248-2217
(816) 248-3450
Mailing address
PO BOX 7687, COLUMBIA, MO 65205-7687
(573) 882-2259
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN87924
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127158
BLUE CHOICE
MO
01
—
292101
UNITED HEALTCARE
MO
01
—
4286845601
KANSAS MEDICAID
MO
Enumeration date
05/16/2006
Last updated
12/26/2007
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