Healthcare Provider Details

I. General information

NPI: 1124477096
Provider Name (Legal Business Name): DISTRICT PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PENNSYLVANIA AVE SE FL 2
WASHINGTON DC
20003-2493
US

IV. Provider business mailing address

215 C ST SE APT 504
WASHINGTON DC
20003-1947
US

V. Phone/Fax

Practice location:
  • Phone: 202-446-1085
  • Fax: 202-446-1086
Mailing address:
  • Phone: 202-446-0185
  • Fax: 202-446-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. WESLEY E COOK
Title or Position: MEDICAL DIRECTOR
Credential: DNP, APRN
Phone: 202-446-1085