Provider Demographics
NPI:1831769231
Name:COOK, HEIDI ANNA (MA, MSN,PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ANNA
Last Name:COOK
Suffix:
Gender:F
Credentials:MA, MSN,PMHNP-BC
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Mailing Address - Street 1:12359 SUNRISE VALLEY DR STE 320
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3463
Mailing Address - Country:US
Mailing Address - Phone:703-596-4797
Mailing Address - Fax:703-787-8210
Practice Address - Street 1:12359 SUNRISE VALLEY DR STE 320
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3463
Practice Address - Country:US
Practice Address - Phone:703-596-4796
Practice Address - Fax:703-787-8210
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024181691363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health