Theil L Cooke Jr., APRN
Individual provider Active NPI Family Nurse Practitioner · Hildale, UT
NPI 1790326353 · NPPES record last updated Feb 1, 2023
Key facts
- NPI
- 1790326353
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 8273152-8900 (UT)
- Practice address
- 1070 N Hildale St # 750
Hildale, UT 84784-7770 - Phone
- (352) 165-4884
- Fax
- (435) 216-5969
- NPI assigned
- Oct 4, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1070 N Hildale St
Suite 750
Hildale, UT 84784-7770
Phone (435) 216-5488
Hospital & facility affiliations
- St. George Regional Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210426001670 | UT | Practitioner - Nurse Practitioner | 9739516824 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8273152-8900 | UT | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Creek Valley Health Clinic | Current |
Accepting new patients | |
| Hometown Wellness PLLC | Current |
Accepting new patients |
Interoperability endpoints
- hometownwellness.theilcooke@162162.advancedmd-direct.com
- https://fhir4.healow.com/fhir/r4/IGHIBD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 233616 | AZ | |
| Family Nurse Practitioner | 363LF0000X | 8273152-8900 | UT | Yes |
| Emergency Registered Nurse | 163WE0003X | RN178632 | AZ |
Addresses
Primary practice location
1070 N Hildale St # 750
Hildale, UT 84784-7770
Mailing address
340 W Harker Ave # 750
Colorado City, AZ 86021-6198
Phone (928) 377-0629
Other practice location 1
20 S. Colvin St
Colorado City, AZ 86021
Phone (928) 377-0629
Other practice location 2
3269 N Stockton Hill Rd
Kingman, AZ 86409-3619
Phone (928) 681-8678
Other providers in Hildale, UT
- Lehi Samuel Barlow
- Lloyd H. Barlow
- Martha Barlow
- Shirley J. Barlow
- Brightside Counseling
- Natasha Deal
- Sarah Draper
- Roxianne Dutson
- Tyson Hannig
- Hildale Dental
All providers in Hildale, UT · Family Nurse Practitioner in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.