Provider Demographics
NPI:1184805517
Name:COOK, JAMIE ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ROSE
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 1:1220 E ELM ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2850
Mailing Address - Country:US
Mailing Address - Phone:419-226-5180
Mailing Address - Fax:419-998-4517
Practice Address - Street 1:1220 E ELM ST
Practice Address - Street 2:SUITE 106
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2850
Practice Address - Country:US
Practice Address - Phone:419-226-5180
Practice Address - Fax:419-998-4517
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0070651Medicaid
OH0070651Medicaid