Provider Demographics
NPI:1093316952
Name:COOK, JENNIFER HUME
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HUME
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:601-200-3376
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:106 HIGHLAND WAY STE 203
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6933
Practice Address - Country:US
Practice Address - Phone:601-200-3376
Practice Address - Fax:601-853-2975
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903684163W00000X
MS905600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse