1629273834 NPI number — DR. KAREN A DECOCKER DNP, PMHNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629273834 NPI number — DR. KAREN A DECOCKER DNP, PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DECOCKER
Provider First Name:
KAREN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANDOCK
Provider Other First Name:
KAREN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629273834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8000 WARREN WOODS RD LOT 68
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THREE OAKS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49128-9573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-220-4676
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 E OAKHILL DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTMONT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60559-5540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-220-4676
Provider Business Practice Location Address Fax Number:
574-406-7309
Provider Enumeration Date:
06/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  209013436 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 290.013436 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 277.003915 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5215366 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".