Provider Demographics
NPI:1134267198
Name:COOK, DELORES GWENDOLYN (FNP)
Entity type:Individual
Prefix:
First Name:DELORES
Middle Name:GWENDOLYN
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HOSPITAL DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2415
Mailing Address - Country:US
Mailing Address - Phone:903-872-3005
Mailing Address - Fax:903-872-3050
Practice Address - Street 1:400 HOSPITAL DR
Practice Address - Street 2:SUITE #106
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2489
Practice Address - Country:US
Practice Address - Phone:903-872-2923
Practice Address - Fax:903-872-2941
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX505742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y226OtherMEDICARE GROUP
TX00Y226OtherMEDICARE GROUP
TX8F6256Medicare PIN