Provider Demographics
NPI:1154949162
Name:COOKE, JEFFREY ALAN (FNP-C)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALAN
Last Name:COOKE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1394
Mailing Address - Country:US
Mailing Address - Phone:607-547-3456
Mailing Address - Fax:
Practice Address - Street 1:739 STATE ROUTE 28
Practice Address - Street 2:SUITE 9
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820
Practice Address - Country:US
Practice Address - Phone:607-431-1015
Practice Address - Fax:607-431-1050
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY793798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily