Provider Demographics
NPI:1023052271
Name:COOK BECKER, MICHELLE D (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:COOK BECKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 PATTERSON ST STE 502
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6511
Mailing Address - Country:US
Mailing Address - Phone:615-515-1900
Mailing Address - Fax:
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD STE 300C
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2384
Practice Address - Country:US
Practice Address - Phone:616-515-1900
Practice Address - Fax:615-292-4633
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA501363AM0700X
KY501363AS0400X
TN1900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531508Medicaid
TNP01161026OtherRR MEDICARE
TN4344466OtherBCBS
KYS964851Medicare UPIN
TN103I970050Medicare PIN
KY1459525Medicare PIN
KY970018840Medicare PIN
KYP00624298OtherRAILROAD MEDICARE