Provider Demographics
NPI:1568856458
Name:COOK, JESSICA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:COOK
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:PO BOX 100181
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3141
Mailing Address - Country:US
Mailing Address - Phone:828-202-5200
Mailing Address - Fax:
Practice Address - Street 1:77 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4435
Practice Address - Country:US
Practice Address - Phone:828-257-4745
Practice Address - Fax:425-382-4001
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60542587363A00000X
NC0010-13187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1568856458Medicaid
WA2044862Medicaid