Provider Demographics
NPI:1215426010
Name:COOK, KIMBERLY ANN (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:COOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41680 MISS BESSIE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2963
Mailing Address - Country:US
Mailing Address - Phone:301-997-1788
Mailing Address - Fax:301-997-1790
Practice Address - Street 1:41680 MISS BESSIE DR STE 102
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2963
Practice Address - Country:US
Practice Address - Phone:301-997-1788
Practice Address - Fax:301-997-1790
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196966363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology