Basic Information
| Provider Information | |||||||||
| NPI: | 1073046496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1307 FEDERAL ST | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123593682 | ||||||||
| FaxNumber: | 4123598541 | ||||||||
| Practice Location | |||||||||
| Address1: | 1307 FEDERAL ST | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123593682 | ||||||||
| FaxNumber: | 4123598541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2017 | ||||||||
| LastUpdateDate: | 06/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP017381 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 103296546 | 05 | PA | MEDICAID |