Individual
DERRICK D KOOKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2312 N NEVADA AVE STE 235, COLORADO SPRINGS, CO 80907-5312
(719) 776-7600
(719) 473-3553
Mailing address
2222 N NEVADA AVE, SUITE, COLORADO SPRINGS, CO 80907-6819
(719) 776-7600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA961
KY
363AS0400X
Surgical Physician Assistant
Primary
PA.0003166
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100001170
—
KY
01
—
P00604454
RAILROAD MEDICARE
KY
Enumeration date
11/17/2005
Last updated
02/09/2026
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