MEDICARE: HEATHER MARIE COOKSEY 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
1	363LF0000X	Family Nurse Practitioner	95023641	CA

General Provider Information

NPI Number	:	1952012049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MARIE COOKSEY FNP

Provider Business Mailing Address
First Line	:	3634 ELIZABETH ST
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-2506
Country	:	US
Telephone Number	:	760-927-7836
Fax Number	:

Provider Business Practice Location Address
First Line	:	12810 TARRAGON WAY
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-7081
Country	:	US
Telephone Number	:	760-927-7836
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	04/07/2026

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