Healthcare Provider Details

I. General information

NPI: 1346094455
Provider Name (Legal Business Name): JACOB COOKE BCFDN-P, CHHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 MONTGOMERY HWY STE 14B
HOOVER AL
35216-4585
US

IV. Provider business mailing address

8872 GADSDEN HIGHWAY PMB 121
TRUSSVILLE AL
35173
US

V. Phone/Fax

Practice location:
  • Phone: 205-609-1073
  • Fax:
Mailing address:
  • Phone: 205-609-1073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: