Healthcare Provider Details

I. General information

NPI: 1730607227
Provider Name (Legal Business Name): JAMIE CHRISTINE COOK APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 CAMELOT DR
WASHINGTON IL
61571-2331
US

IV. Provider business mailing address

8940 N WOOD SAGE RD
PEORIA IL
61615-7822
US

V. Phone/Fax

Practice location:
  • Phone: 309-229-1959
  • Fax:
Mailing address:
  • Phone: 309-243-3000
  • Fax: 309-243-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016479
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277001181
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: