Healthcare Provider Details

I. General information

NPI: 1093316952
Provider Name (Legal Business Name): JENNIFER HUME COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 HIGHLAND WAY STE 203
MADISON MS
39110-6933
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-3376
  • Fax: 601-853-2975
Mailing address:
  • Phone: 601-200-3376
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number903684
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number905600
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: