MEDICARE: MS. JAMIE COOK FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	652857	TX

General Provider Information

NPI Number	:	1720538093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAMIE COOK FNP-BC

Provider Business Mailing Address
First Line	:	3328 N UNIVERSITY DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2681
Country	:	US
Telephone Number	:	936-568-3141
Fax Number	:	936-560-3872

Provider Business Practice Location Address
First Line	:	3328 N UNIVERSITY DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2681
Country	:	US
Telephone Number	:	936-568-3141
Fax Number	:	936-560-3872

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2016
Last Update Date	:	02/03/2025

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