Provider Demographics
NPI:1801096417
Name:COOK, KERRI A (ANP)
Entity type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:A
Last Name:COOK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MISS
Other - First Name:KERRI
Other - Middle Name:
Other - Last Name:RANDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:900 MOHAWK STREET STE E
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419
Mailing Address - Country:US
Mailing Address - Phone:912-925-0067
Mailing Address - Fax:912-629-0281
Practice Address - Street 1:9665 FORD AVENUE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324
Practice Address - Country:US
Practice Address - Phone:912-756-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-21
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN143588163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse