=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538963376
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA COOK FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2025
-----------------------------------------------------
Last Update Date | 04/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 E ORANGE ST
-----------------------------------------------------
City | HOOPESTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60942-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-283-5644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 334
-----------------------------------------------------
City | WESTVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61883-0334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-213-9243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 209.030546
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------