Provider Demographics
NPI:1053910547
Name:COOK, DEVON (NP)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 STOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8927
Mailing Address - Country:US
Mailing Address - Phone:704-868-6209
Mailing Address - Fax:
Practice Address - Street 1:3037 STOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8927
Practice Address - Country:US
Practice Address - Phone:704-833-8576
Practice Address - Fax:980-448-3296
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily