Individual
MASHARA S COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
460 BRIARWOOD DR STE 510, JACKSON, MS 39206-3057
(601) 956-4816
(601) 956-4817
Mailing address
460 BRIARWOOD DR STE 510, JACKSON, MS 39206-3057
(601) 956-4816
(601) 956-4817
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01670076
—
MS
Enumeration date
12/11/2018
Last updated
12/11/2018
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