Healthcare Provider Details

I. General information

NPI: 1265529929
Provider Name (Legal Business Name): GINGER M COOK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 HOSPITAL DR SUITE 200
CARTHAGE TN
37030-4004
US

IV. Provider business mailing address

133 HOSPITAL DR SUITE 200
CARTHAGE TN
37030-4004
US

V. Phone/Fax

Practice location:
  • Phone: 615-735-3450
  • Fax: 615-735-3460
Mailing address:
  • Phone: 615-735-3450
  • Fax: 615-735-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6473
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: