Healthcare Provider Details

I. General information

NPI: 1073858049
Provider Name (Legal Business Name): JENNIFER KAYE COOK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 S MILLENIUM WAY
MERIDIAN ID
83642-6439
US

IV. Provider business mailing address

1618 S MILLENIUM WAY
MERIDIAN ID
83642-6439
US

V. Phone/Fax

Practice location:
  • Phone: 208-884-3376
  • Fax: 208-884-0858
Mailing address:
  • Phone: 208-884-3376
  • Fax: 208-884-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1525A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: