Healthcare Provider Details

I. General information

NPI: 1609673193
Provider Name (Legal Business Name): JENNIFER RENAE COOK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 OLD US 70 E
BLACK MOUNTAIN NC
28711-9488
US

IV. Provider business mailing address

6 HALF MOON DR # B
SWANNANOA NC
28778-8318
US

V. Phone/Fax

Practice location:
  • Phone: 828-669-9991
  • Fax:
Mailing address:
  • Phone: 828-808-5915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5021773
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: