Provider Demographics
NPI:1295232510
Name:COOK, JACQUELYN MARIE (APRN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210062 PINECONE DR
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-6716
Mailing Address - Country:US
Mailing Address - Phone:720-475-6626
Mailing Address - Fax:
Practice Address - Street 1:210062 PINECONE DR
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-6716
Practice Address - Country:US
Practice Address - Phone:720-465-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE88549163W00000X
NE115792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse