Provider Demographics
NPI:1831575026
Name:BOOKER, COZZETTE K (PMHNP-BC, AGNP-C,)
Entity type:Individual
Prefix:
First Name:COZZETTE
Middle Name:K
Last Name:BOOKER
Suffix:
Gender:F
Credentials:PMHNP-BC, AGNP-C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 ROUNDTOP RD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-3314
Mailing Address - Country:US
Mailing Address - Phone:540-892-6631
Mailing Address - Fax:
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:PRIMARY CARE CLINIC 1
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:540-224-1904
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173569363LA2200X, 363LP0808X
VA0001208365163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse