Healthcare Provider Details

I. General information

NPI: 1437526225
Provider Name (Legal Business Name): JESSICA ANN COOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ANN EVANS

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER BOULEVARD DIVISION OF RADIOLOGIC SCIENCE
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

ONE MEDICAL CENTER BOULEVARD DIVISION OF RADIOLOGIC SCIENCE
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-1066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.45767
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2026-01557
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number4605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: