Provider Demographics
NPI:1720344229
Name:COOK, KERRY ANN (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:KERRY
Middle Name:ANN
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 1:3031 JAVIER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4637
Mailing Address - Country:US
Mailing Address - Phone:703-914-8000
Mailing Address - Fax:703-914-0064
Practice Address - Street 1:3031 JAVIER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4637
Practice Address - Country:US
Practice Address - Phone:703-914-8000
Practice Address - Fax:703-914-0064
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003854363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical