Individual
KRISTA NICOLE COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1552 W DUPONT AVE, SALT LAKE CITY, UT 84116-3651
(801) 726-9043
Mailing address
1552 W DUPONT AVE, SALT LAKE CITY, UT 84116-3651
(801) 726-9043
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
363A00000X
Physician Assistant
Primary
5830482-1206
UT
363AM0700X
Medical Physician Assistant
5830482-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/29/2018
Last updated
04/05/2022
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