Provider Demographics
NPI:1942195607
Name:COOKE, BRYAN (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:COOKE
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 ADOLPHUS CORDELL RD
Mailing Address - Street 2:
Mailing Address - City:ROAN MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37687-3238
Mailing Address - Country:US
Mailing Address - Phone:423-612-2880
Mailing Address - Fax:
Practice Address - Street 1:1025 EXECUTIVE PARK BLVD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4620
Practice Address - Country:US
Practice Address - Phone:423-571-2249
Practice Address - Fax:423-571-2249
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38701363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health