Provider Demographics
NPI:1609673193
Name:COOK, JENNIFER RENAE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENAE
Last Name:COOK
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HALF MOON DR # B
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-8318
Mailing Address - Country:US
Mailing Address - Phone:828-808-5915
Mailing Address - Fax:
Practice Address - Street 1:611 OLD US 70 E
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-9488
Practice Address - Country:US
Practice Address - Phone:828-669-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily