MEDICARE: EBONY JOY COOKE PA

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	363A00000X	Physician Assistant	11485	GA
2	363A00000X	Physician Assistant	0010-16130	NC

General Provider Information

NPI Number	:	1851062012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY JOY COOKE PA

Provider Business Mailing Address
First Line	:	PO BOX 360
Second Line	:
City	:	SYLVA
State	:	NC
Zip	:	28779-0360
Country	:	US
Telephone Number	:	888-339-6065
Fax Number	:	828-538-4441

Provider Business Practice Location Address
First Line	:	10616 METROMONT PKWY STE 210
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-7670
Country	:	US
Telephone Number	:	704-774-6569
Fax Number	:	855-308-2340

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

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	01/20/2026

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