Basic Information
| Provider Information | |||||||||
| NPI: | 1235793415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | KRISTEN | ||||||||
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| Credential: | MSN, APRN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2802 ROYAL CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | KINGWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773392433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132916053 | ||||||||
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| Practice Location | |||||||||
| Address1: | 233 SGT ED HOLCOMB BLVD S | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773041990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9367568331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2019 | ||||||||
| LastUpdateDate: | 04/23/2019 | ||||||||
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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 | 363LP0808X | AP141206 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.