Healthcare Provider Details

I. General information

NPI: 1902677511
Provider Name (Legal Business Name): JENNIFER COOK PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 US HIGHWAY 90 STE 103
DAPHNE AL
36526-9510
US

IV. Provider business mailing address

600 SUN TEMPLE DR
MADISON AL
35758-8643
US

V. Phone/Fax

Practice location:
  • Phone: 256-701-5651
  • Fax:
Mailing address:
  • Phone: 256-975-4291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberPENDING
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: