Provider Demographics
NPI:1891728416
Name:COOK, ASHLY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ASHLY
Middle Name:
Last Name:COOK
Suffix:
Gender:M
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 1:120 WILLIAM PENN PLZ
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2150
Mailing Address - Country:US
Mailing Address - Phone:919-220-5255
Mailing Address - Fax:919-313-1276
Practice Address - Street 1:540 NORTH ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4016
Practice Address - Country:US
Practice Address - Phone:919-934-1094
Practice Address - Fax:919-934-9044
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102394363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2752672DMedicare PIN
S93511Medicare UPIN
NC2752672CMedicare ID - Type Unspecified
P00297985Medicare ID - Type UnspecifiedRR MEDICARE #