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NPI Code Detail

MEDICARE: DERRICK D KOOKER P.A.

MEDICARE: DERRICK D KOOKER P.A.
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
1363AS0400XSurgical Physician AssistantPA.0003166CO
2363A00000XPhysician AssistantPA961KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00604454OTHERKYRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851373526
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK D KOOKER P.A.
Provider Business Mailing Address
First Line : 2222 N NEVADA AVE
Second Line : SUITE
City : COLORADO SPRINGS
State : CO
Zip : 80907-6819
Country : US
Telephone Number : 719-776-7600
Fax Number :
Provider Business Practice Location Address
First Line : 2312 N NEVADA AVE STE 235
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-5312
Country : US
Telephone Number : 719-776-7600
Fax Number : 719-473-3553
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2005
Last Update Date : 02/09/2026

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Directions to “ DERRICK D KOOKER P.A.” Practice Location

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