Healthcare Provider Details

I. General information

NPI: 1962881557
Provider Name (Legal Business Name): NAKITA MILHOUSE-COOK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MONTLIMAR DR STE 100
MOBILE AL
36609-1718
US

IV. Provider business mailing address

1201 MONTLIMAR DR STE 100
MOBILE AL
36609-1718
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-0989
  • Fax: 251-343-0792
Mailing address:
  • Phone: 251-343-0989
  • Fax: 251-343-0792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-087071
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-087071
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: