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NPI Code Detail

MEDICARE: MRS. NAKITA DOREZ COOK FNP

MEDICARE: MRS. NAKITA DOREZ COOK FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209016704IL
2363LP0808XPsychiatric/Mental Health Nurse Practitioner277.001745IL

General Provider Information

NPI Number : 1710496021
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NAKITA DOREZ COOK FNP
Provider Business Mailing Address
First Line : 320 E CENTRAL AVE
Second Line :
City : DECATUR
State : IL
Zip : 62521-4665
Country : US
Telephone Number : 217-877-9117
Fax Number :
Provider Business Practice Location Address
First Line : 320 E CENTRAL AVE
Second Line :
City : DECATUR
State : IL
Zip : 62521-4665
Country : US
Telephone Number : 217-877-9117
Fax Number : 217-877-9117
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2017
Last Update Date : 04/15/2026

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