MR. CONNIE DALE COOK II (NPI# 1164426128) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164426128 |
| Entity Type | Individual |
| Full Name | MR. CONNIE DALE COOK II |
| Credential | PAC |
| Practice Address |
600 E Mcdonald Ave Man WV 25635-1097 |
| Mailing Address |
1650 Main Street Pineville WV 24874-1650 |
| Practice Telephone | 3045836541 |
| Practice Fax Number | 3045836018 |
| Mailing Telephone | 3047326735 |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2010-02-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
626 | WV | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | 3810000560 | 05 |
| Street Address |
600 E MCDONALD AVE |
| City | MAN |
| State | WV |
| Zip Code | 25635-1097 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700880762 | Rachel Leigh Stover | Nurse Practitioner | 600 E Mcdonald Ave, Man, WV 25635-1023 | 2005-06-08 |
| 1477174035 | Lincoln County Primary Care Center Inc | Clinic/Center | 600 E Mcdonald Ave, Man, WV 25635-1023 | 2020-05-05 |
| 1881918837 | Man Rexcellence Program | Pharmacy | 600 E Mcdonald Ave, Man, WV 25635-1023 | 2010-03-19 |
| 1689997678 | Lincoln County Primary Care Center, Inc. | Clinic/Center | 600 E Mcdonald Ave, Man, WV 25635-1023 | 2010-03-05 |
| 1427201060 | Regina A. Bias | Clinical Nurse Specialist | 600 E Mcdonald Ave, Man, WV 25635-1023 | 2008-10-28 |
| 1225227549 | Alice Childers | Radiologic Technologist | 600 E Mcdonald Ave, Man, WV 25635-1023 | 2007-10-23 |
| 1295924512 | Michelle L. Toler | Radiologic Technologist | 600 E Mcdonald Ave, Man, WV 25635-1023 | 2007-10-23 |
| 1033205836 | Community Health Foundation | Dentist | 600 E Mcdonald Ave, Man, WV 25635-1023 | 2006-10-05 |
| 1255335212 | Radhakrishna M Bellam | Family Medicine | 600 E Mcdonald Ave, Man, WV 25635-1023 | 2005-06-08 |
| 1700880747 | Enrico V Rallos | Family Medicine | 600 E Mcdonald Ave, Man, WV 25635-1023 | 2005-06-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902456718 | Jennifer Lynn Fletcher | Registered Nurse | 800 East Mcdonald Avenue, Man, WV 25635 | 2019-09-13 |
| 1497122469 | Bio-medical Applications of West Virginia, Inc. | Clinic/Center | 308 Huff Creek Highway, Man, WV 25635 | 2015-08-26 |
| 1053660167 | Misty Linville Collins | Pharmacist | 650 East Mcdonald Ave, Man, WV 25635 | 2012-09-05 |
| 1760551618 | Community Prescription Center Inc | Durable Medical Equipment & Medical Supplies | 124 Main St, Man, WV 25635 | 2006-11-07 |
| 1902835010 | Family Healthcare Associates Inc | Family Medicine | 114 Main Street, Man, WV 25635-0114 | 2006-07-01 |
| 1780090167 | Julie Ann Walls | Nurse Practitioner | 650 E Mcdonald Ave, Man, WV 25635-1012 | 2014-07-07 |
| 1033370051 | Philip A Galapon | Family Medicine | 650 E Mcdonald Ave, Man, WV 25635-1012 | 2008-06-23 |
| 1750363685 | Christopher Joseph Tipton | Physician Assistant | 650 E Mcdonald Ave, Man, WV 25635-1012 | 2005-11-16 |
| 1225175102 | Terri D Doss | Pharmacist | 601 E Mcdonald Ave, Prescription Center, Man, WV 25635-1022 | 2007-01-31 |
| 1184620841 | Community Health Foundation of Man Wv | Clinic/Center | 600 East Mcdonald Avenue, Man, WV 25635-1023 | 2005-06-27 |
| Find all providers in zip 25635 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386270908 | Bonnie Lynn Blackburn | Physician Assistant | 10 Amalia Dr Ste C5, Buckhannon, WV 26201-2270 | 2020-03-15 |
| 1922638824 | Sara B Johnson | Physician Assistant | 1000 Mon Health Medical Park Dr Ste 1100, Morgantown, WV 26505-1143 | 2020-01-19 |
| 1659835072 | Kristen Nicole Williams | Physician Assistant | 26 Portsmouth Ct N, Falling Waters, WV 25419-1430 | 2019-01-30 |
| 1629588876 | Robert Theodore Hartman | Physician Assistant | 620 National Rd Ste 300, Wheeling, WV 26003-6560 | 2017-10-02 |
| 1366967986 | Terri Leanne Belcher | Physician Assistant | 395 Emily Dr, Clarksburg, WV 26301-5505 | 2017-08-04 |
| 1760937056 | Ryan Aston | Physician Assistant | 58 16th St Fl 4, Wheeling, WV 26003-3660 | 2016-08-17 |
| 1821470113 | Lesley E. Weiss | Physician Assistant | 3200 Maccorkle Seave, Charleston, WV 25304-1227 | 2015-06-23 |
| 1891197323 | Rachelle Lyle Stewart | Physician Assistant | 1500 Terrace St Ste 105, Hinton, WV 25951-9768 | 2014-09-16 |
| 1285043224 | Sarah Gutman Brammer | Physician Assistant | 30 Medical Park Ste 211, Wheeling, WV 26003-6391 | 2014-08-04 |
| 1841603529 | Timothy Douglas | Physician Assistant | 4202 Mccorkle Ave Sw Ste 200, South Charleston, WV 25309-1513 | 2014-06-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.