Provider Demographics
NPI:1225066517
Name:COOK, JEZERIAH WAYNE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEZERIAH
Middle Name:WAYNE
Last Name:COOK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:9 MANHATTAN SQ STE A
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6262
Mailing Address - Country:US
Mailing Address - Phone:757-838-6335
Mailing Address - Fax:757-838-0612
Practice Address - Street 1:9 MANHATTAN SQ STE A
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6262
Practice Address - Country:US
Practice Address - Phone:757-838-6335
Practice Address - Fax:757-838-0612
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2014-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110002140363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant