Provider Demographics
NPI:1568278778
Name:PROKOS, NIKKI ALEXANDRA (PA-C)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:ALEXANDRA
Last Name:PROKOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 BARCLAY LN
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-2235
Mailing Address - Country:US
Mailing Address - Phone:224-456-0684
Mailing Address - Fax:
Practice Address - Street 1:1337 BARCLAY LN
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-2235
Practice Address - Country:US
Practice Address - Phone:224-456-0684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant