Healthcare Provider Details

I. General information

NPI: 1154093748
Provider Name (Legal Business Name): JAMES DAVID COOK JR. NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 02/11/2023
Certification Date: 02/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 UNIVERSITY DR BLDG 700
DURHAM NC
27707-3489
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 919-237-1337
  • Fax: 919-237-1625
Mailing address:
  • Phone: 336-716-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07210632
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: