Provider Demographics
NPI:1124051099
Name:COOK, KIMBERLY E (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:E
Last Name:COOK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4017
Mailing Address - Country:US
Mailing Address - Phone:410-414-4791
Mailing Address - Fax:410-535-8417
Practice Address - Street 1:14090 HG TRUEMAN RD STE 2100
Practice Address - Street 2:
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-3151
Practice Address - Country:US
Practice Address - Phone:410-394-3712
Practice Address - Fax:410-394-3714
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR134606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003982900Medicaid
DC13070005OtherCAREFIRST BCBS OF DC
MD64804501OtherCAREFIRST BCBS
MD64804501OtherCAREFIRST BCBS
MD003982900Medicaid