Healthcare Provider Details

I. General information

NPI: 1861732521
Provider Name (Legal Business Name): JESSICA LYNN COOK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 07/30/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 KILDAIRE FARM RD
CARY NC
27518-6616
US

IV. Provider business mailing address

1017 OLD MEETINGHOUSE WAY
RALEIGH NC
27615-1698
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8000
  • Fax:
Mailing address:
  • Phone: 813-965-1766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number346712
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: