Provider Demographics
NPI:1780624510
Name:COOKSEY, BOBBIE JEAN (FNP C)
Entity type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:JEAN
Last Name:COOKSEY
Suffix:
Gender:F
Credentials:FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:951 MATTHEW DR
Mailing Address - Street 2:STE D
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2566
Mailing Address - Country:US
Mailing Address - Phone:601-671-2795
Mailing Address - Fax:601-735-4227
Practice Address - Street 1:920 MATTHEW DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367
Practice Address - Country:US
Practice Address - Phone:601-735-3918
Practice Address - Fax:601-735-4227
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR558486363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09455703Medicaid
Q16087Medicare UPIN
MS09455703Medicaid