Individual
JACKLINE OTIENO COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1300 W TERRELL AVE STE K230, FORT WORTH, TX 76104-3104
(817) 250-4906
Mailing address
1300 W TERRELL AVE STE K230, FORT WORTH, TX 76104-3104
(817) 250-4906
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
A
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
363LA2100X
TAXONOMY CODE
TX
Enumeration date
09/26/2022
Last updated
02/11/2025
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