NPI 1033628383

Jordan Fayth Cooke, PAC

Practitioner Surgical Physician Assistant Tyler, TX

Practice location

Address: 8101 S Broadway Ave, Tyler, TX 75703-5469
Phone: (903) 939-7500
Fax: (903) 939-7728
Mailing address: 3414 Golden Rd, Tyler, TX 75701-8336

Registered specialties

Surgical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AS0400X Licence PA11584 (TX)

Other Physician Assistant providers in Texas →

Registry record

NPI: 1033628383
Entity type: Individual
Sex (as registered): Female
NPI issued: 28 Sep 2017
Record last updated: 22 Feb 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.