MEDICARE: MS. BRIDGETTE ANN COOKE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-08190	NC

General Provider Information

NPI Number	:	1023504735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRIDGETTE ANN COOKE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1845
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28687-1845
Country	:	US
Telephone Number	:	704-873-4277
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 SIGNAL HILL DR STE C
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28625-4483
Country	:	US
Telephone Number	:	704-871-8999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2018
Last Update Date	:	12/08/2020

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