Provider Demographics
NPI:1629273834
Name:DECOCKER, KAREN A (DNP, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:A
Last Name:DECOCKER
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:SANDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8000 WARREN WOODS RD LOT 68
Mailing Address - Street 2:
Mailing Address - City:THREE OAKS
Mailing Address - State:MI
Mailing Address - Zip Code:49128-9573
Mailing Address - Country:US
Mailing Address - Phone:574-220-4676
Mailing Address - Fax:
Practice Address - Street 1:1 E OAKHILL DR STE 100
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5540
Practice Address - Country:US
Practice Address - Phone:574-220-4676
Practice Address - Fax:574-406-7309
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013436363LP0808X
IL290.013436363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5215366Medicaid
MI5215366Medicaid
MI0A14742011Medicare PIN