Healthcare Provider Details

I. General information

NPI: 1992629968
Provider Name (Legal Business Name): ROXANN COZETTE DHOM PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S SCOTT AVE
NEWTON IL
62448-1658
US

IV. Provider business mailing address

1225 E WEISGARBER RD STE 190
KNOXVILLE TN
37909-2696
US

V. Phone/Fax

Practice location:
  • Phone: 618-783-2309
  • Fax:
Mailing address:
  • Phone: 423-259-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209022282
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: