Jennifer Cooke Staat, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2505 Issued in NC

Practice address

4608 Cedar Ave
Suite 106
Wilmington, NC 28403-4419

Phone

(910) 547-3093

NPI assigned

Dec 29, 2005

Last updated

Oct 30, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Jennifer Lee Cooke Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jennifer Cooke Staat, P.a.

  dba Northstar Psychology

  • Psychologist
  • Wilmington, NC
  • NPI 1205083532
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193702400000",
    "number": "1902883119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4608 CEDAR AVENUE",
            "address_2": "SUITE 106",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28403",
            "telephone_number": "910-547-3093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4608 CEDAR AVE",
            "address_2": "SUITE 106",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284034419",
            "telephone_number": "910-547-3093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAAT",
        "first_name": "JENNIFER",
        "middle_name": "COOKE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-29",
        "last_updated": "2007-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "2505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCH",
            "identifier": "240133",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000577",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "046K0",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "D6590",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "NCMC034119",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "COOKE",
            "middle_name": "LEE",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• SSC Wilmington Operating Company LLC (Wilmington Health and Rehabilitation Center)
• Danielle Theresa St Hilaire, DO
• Sydney St Jean
• Brittany Nicole St. John, MSW, LCSW
• St. Mary's Home Care Services, Inc.
• Morgan Renee Stachowiak, MS, CCC-SLP
• Benjamin Ryan Staley
• Cameron Staley
• Jacob Staley
• Melissa Staley, MS

• Psychologist in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.