Healthcare Provider Details

I. General information

NPI: 1891769923
Provider Name (Legal Business Name): CYNTHIA C COOKE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PRIMARY CARE CLINIC 4100 GOSS RD FOX ARMY HEALTH CENTER
REDSTONE ARSENAL AL
35809-7000
US

IV. Provider business mailing address

CREDENTIALS COORDINATOR, 4100 GOSS RD FOX ARMY HEALTH CENTER
REDSTONE ARSENAL AL
35898-7000
US

V. Phone/Fax

Practice location:
  • Phone: 256-955-8888
  • Fax: 256-313-3260
Mailing address:
  • Phone: 256-955-8888
  • Fax: 256-313-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-058107
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: