Most Relevant Information
Provider Data
| NPI Number: | 1003069113 |
| Provider Name: | CRYSTAL S COOK CFNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | R855632 |
Most Important Dates
| Enumeration Date: | 11/03/2008 |
| Last Updated: | 09/01/2011 |
Provider Practice Location
225 COMMUNITY DRIVE
FAYETTE
MS
390690098
Practice Location Phone/Fax
| Phone: | 6017863475 |
| Fax: | 6017869980 |
Provider Mailing Location
PO BOX 98
FAYETTE
MS
390690098
Provider Mailing Phone/Fax
| Phone: | 6017863475 |
| Fax: | 6017869980 |