1124051099 NPI number — MRS. KIMBERLY E COOK C.R.N.P.

Table of content: MRS. KIMBERLY E COOK C.R.N.P. (NPI 1124051099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124051099 NPI number — MRS. KIMBERLY E COOK C.R.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
KIMBERLY
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124051099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HOSPITAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCE FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20678-4017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-414-4791
Provider Business Mailing Address Fax Number:
410-535-8417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14090 HG TRUEMAN RD STE 2100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOLOMONS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20688-3151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-394-3712
Provider Business Practice Location Address Fax Number:
410-394-3714
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R134606 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003982900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13070005 . This is a "CAREFIRST BCBS OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 64804501 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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