Kelly R Cook, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA03756 Issued in TX

Practice address

580 S Denton Tap Rd Ste 123
Coppell, TX 75019-4099

Phone

(972) 462-0762

Fax

(972) 393-2133

NPI assigned

Oct 4, 2006

Last updated

Jun 23, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Frisco Total Wellness Clinic, PLLC

  • Adult Medicine Physician
  • Frisco, TX
  • NPI 1073018131
  NPD (past)
• Physicians and Allied Health Professionals Group, PA

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1528011814
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245715200000",
    "number": "1760577043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 S DENTON TAP RD STE 123",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750194099",
            "telephone_number": "972-462-0762",
            "fax_number": "972-393-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 S DENTON TAP RD STE 123",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750194099",
            "telephone_number": "972-462-0762",
            "fax_number": "972-393-2133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "KELLY",
        "middle_name": "R",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2009-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Brian Conerly
• Amanda Conklin
• Lauren Eilzabeth Conley
• Laila Connish, RBT
• Jon-Michael Cook, M.D.
• Cooksey Counseling, PLLC
• Nathan Cooksey, LPC
• Nolan Richard Coon, PT, DPT
• Bailey Marie Cooper
• Coppell Adult Medicine Specialist

• Physician Assistant in Coppell, TX
• Providers in Coppell, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.