Provider Demographics
NPI:1952113300
Name:COOK, BRIANNA (PA-C)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:COOK
Suffix:
Gender:
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 1:6203 SWEET PL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-2817
Mailing Address - Country:US
Mailing Address - Phone:631-897-5484
Mailing Address - Fax:
Practice Address - Street 1:1995 SAINT MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2405
Practice Address - Country:US
Practice Address - Phone:631-897-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant