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General NPI Number Information
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NPI Number | 1003370230
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Entity Type | Individual
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Provider Name | KIMBERLY M COOK
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Gender | Female
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 2500 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-1312
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 COCHRANE CIR UNIT MEDDAC
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City | FORT CARSON
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State | CO
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Zip | 80913-4604
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Country | US
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Telephone | 719-526-7000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA00757
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0006218
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License Number State | CO
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