Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R855632 | MS |
NPI | 1003069113 |
---|---|
Provider Name | Mrs. Crystal S Cook |
First Address | Fayette, MS 39069-0098 |
Second Address | Fayette, MS 39069-0098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2008 |
Last Update Date | 01/09/2011 |