Provider Demographics
NPI:1124844089
Name:COOKS, DV'NN JA'JWAN SR (PA-C)
Entity type:Individual
Prefix:
First Name:DV'NN
Middle Name:JA'JWAN
Last Name:COOKS
Suffix:SR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101
Mailing Address - Country:US
Mailing Address - Phone:702-307-4635
Mailing Address - Fax:
Practice Address - Street 1:1450 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101
Practice Address - Country:US
Practice Address - Phone:702-307-4635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA3122363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical