Provider Demographics
NPI:1043181704
Name:COOK, DAMIAN D
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:D
Last Name:COOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LYNN ST
Mailing Address - Street 2:
Mailing Address - City:BOB WHITE
Mailing Address - State:WV
Mailing Address - Zip Code:25028-9036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 LYNN ST
Practice Address - Street 2:
Practice Address - City:BOB WHITE
Practice Address - State:WV
Practice Address - Zip Code:25028-9036
Practice Address - Country:US
Practice Address - Phone:304-601-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant