Healthcare Provider Details

I. General information

NPI: 1407288459
Provider Name (Legal Business Name): CHARLES DAVID COOK DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CHARLOIS BLVD
WINSTON SALEM NC
27103-1549
US

IV. Provider business mailing address

150 CHARLOIS BLVD
WINSTON SALEM NC
27103-1549
US

V. Phone/Fax

Practice location:
  • Phone: 336-865-0344
  • Fax: 336-765-7306
Mailing address:
  • Phone: 336-865-0344
  • Fax: 336-765-7306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5006328
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5006328
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: