Provider Demographics
NPI:1093489551
Name:COOK, JAMIE DIANE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:DIANE
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 FLATS CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:WV
Mailing Address - Zip Code:26047-2000
Mailing Address - Country:US
Mailing Address - Phone:304-564-3368
Mailing Address - Fax:
Practice Address - Street 1:211 FLATS CEMETERY RD
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:WV
Practice Address - Zip Code:26047-2000
Practice Address - Country:US
Practice Address - Phone:304-564-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1356607394Medicaid
WV1821206228Medicaid
WV1255523494Medicaid