=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124051099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY E COOK C.R.N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 01/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14090 HG TRUEMAN RD STE 2100
-----------------------------------------------------
City | SOLOMONS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20688-3151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-394-3712
-----------------------------------------------------
Fax | 410-394-3714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 HOSPITAL RD
-----------------------------------------------------
City | PRINCE FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20678-4017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-414-4791
-----------------------------------------------------
Fax | 410-535-8417
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R134606
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------