Healthcare Provider Details

I. General information

NPI: 1235793415
Provider Name (Legal Business Name): JENNIFER KRISTEN COOK MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 SGT ED HOLCOMB BLVD S
CONROE TX
77304-1990
US

IV. Provider business mailing address

2802 ROYAL CIRCLE DR
KINGWOOD TX
77339-2433
US

V. Phone/Fax

Practice location:
  • Phone: 936-756-8331
  • Fax:
Mailing address:
  • Phone: 713-291-6053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP141206
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: