Provider Demographics
NPI:1851394589
Name:COOK, KRISTI (FNP)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 SPRATLIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6205
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:2001 E STONEBROOK PL
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4000
Practice Address - Country:US
Practice Address - Phone:423-224-1000
Practice Address - Fax:423-224-1023
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARN1128283363L00000X
TNAPN6418363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7784040Medicaid
TN3649745Medicaid
VA007784040Medicaid
TN3649745Medicare ID - Type Unspecified
VA7784040Medicaid
0281780001Medicare PIN
TN3649745Medicaid
VA007784040Medicaid