Crystal S Cook, CFNP
Individual provider Active NPI Nurse Practitioner · Fayette, MS
NPI 1003069113 · NPPES record last updated Sep 1, 2011
Key facts
- NPI
- 1003069113
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- R855632 (MS)
- Practice address
- 225 Community Drive
Fayette, MS 39069-0098 - Phone
- (601) 786-3475
- Fax
- (601) 786-9980
- NPI assigned
- Nov 3, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Jefferson Comprehensive Health Center, Inc.
Practice addresses (Care Compare)
430 Hwy 33
Fayette, MS 39069-4546
Phone (601) 786-8206
Hospital & facility affiliations
- Sta Home Health Agency of Jackson, Inc. Dba Accentcare Home Health of Jackson
- Merit Health Natchez
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140616002077 | MS | Practitioner - Nurse Practitioner | 4284858184 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R855632 | MS | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jefferson Comprehensive Health Center Inc | Current |
Accepting new patients | |
| Jefferson Comprehensive Health Center, Inc. | Current |
Accepting new patients | |
| Jefferson Comprehensive Health Center, Inc. | Current | Accepting new patients |
Locations
430 Highway 33
Fayette, MS 39069
Phone (601) 786-8206
225 Community Dr
Fayette, MS 39069
Phone (601) 786-2475
405 Main St
Fayette, MS 39069
145 Homochitto St
Natchez, MS 39120
Phone (601) 442-4863
Interoperability endpoints
- https://fhir.yourcareuniverse.net/tenant/32b5092f-40b2-465b-a5fc-fb42387f5279
- https://fhir4.healow.com/fhir/r4/AHEABD/Endpoint/AHEABD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R855632 | MS | Yes |
Addresses
Primary practice location
225 Community Drive
Fayette, MS 39069-0098
Mailing address
PO Box 98
Fayette, MS 39069-0098
Phone (601) 786-3475
Other providers in Fayette, MS
- Matthew Kevin Bounds
- Hattori Almeshia Brice
- CC Reliable Care Services LLC
- Chambliss Counseling Services PLLC
- Sharron Daneka Chambliss
- Tiffany Nicole Cruel
- Gabrielle Doss
- DRG Fayette PLLC
- DRG Fayette, PLLC
- John Ellis Evans
All providers in Fayette, MS · Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.