Provider Demographics
NPI:1376177154
Name:COOK, WESLEY ADAM (PA)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:ADAM
Last Name:COOK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:438 E VANN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-7202
Mailing Address - Country:US
Mailing Address - Phone:423-278-1700
Mailing Address - Fax:423-278-1708
Practice Address - Street 1:438 E VANN RD STE 100
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-7202
Practice Address - Country:US
Practice Address - Phone:423-278-1700
Practice Address - Fax:423-278-1708
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4103363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical