Provider Demographics
NPI:1427873389
Name:COHEN, MARY JEAN (FNP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JEAN
Last Name:COHEN
Suffix:
Gender:F
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 1:109 ALEXANDRA DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28150-9013
Mailing Address - Country:US
Mailing Address - Phone:512-773-7884
Mailing Address - Fax:
Practice Address - Street 1:3031 TATE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1455
Practice Address - Country:US
Practice Address - Phone:828-845-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021198363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology