Healthcare Provider Details

I. General information

NPI: 1538901582
Provider Name (Legal Business Name): ZACHARY T COOK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 GEORGE ST
BECKLEY WV
25801-2653
US

IV. Provider business mailing address

314 GEORGE ST
BECKLEY WV
25801-2653
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-8070
  • Fax:
Mailing address:
  • Phone: 304-252-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number119446
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: