MEDICARE: VICKY LEIGH COOKE-THORNTON ANP-C

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	363L00000X	Nurse Practitioner	900146	NC
2	363L00000X	Nurse Practitioner	8150	TN
3	363L00000X	Nurse Practitioner	GAA-NP002587	GA
4	363L00000X	Nurse Practitioner	RN1300077	TN

General Provider Information

NPI Number	:	1912013426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKY LEIGH COOKE-THORNTON ANP-C

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	16825 ROSMAN HWY
Second Line	:
City	:	LAKE TOXAWAY
State	:	NC
Zip	:	28747-9593
Country	:	US
Telephone Number	:	828-862-6900
Fax Number	:	--

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	10/20/2025

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