Provider Demographics
NPI:1831705953
Name:COOKE, CARLY ANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ANN
Last Name:COOKE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:ANN
Other - Last Name:DICUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:617 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOHENWALD
Mailing Address - State:TN
Mailing Address - Zip Code:38462-1355
Mailing Address - Country:US
Mailing Address - Phone:931-796-4901
Mailing Address - Fax:931-796-6203
Practice Address - Street 1:617 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-1355
Practice Address - Country:US
Practice Address - Phone:931-796-4901
Practice Address - Fax:931-796-6203
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily