Provider Demographics
NPI:1134576101
Name:COOKE, MARY KATHERINE CRAVEN (PA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE CRAVEN
Last Name:COOKE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:623 TAYLOR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5073
Mailing Address - Country:US
Mailing Address - Phone:910-391-0176
Mailing Address - Fax:
Practice Address - Street 1:1814 WESTCHESTER DR STE 101
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7369
Practice Address - Country:US
Practice Address - Phone:336-802-2105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2019-11-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant