Individual provider Active NPI

Breonna Chante Roberts-Cook, APRN, FNP-C

  • Family Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1205782117
Registry record updated Mar 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1228656 Issued in TX
Practice address
3436 S Polk St Ste a
Dallas, TX 75224-3804
Phone
(214) 372-9200
NPI assigned
Mar 5, 2026
Last updated
Mar 5, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1228656 TX Primary

Addresses

Primary practice location

3436 S Polk St Ste a
Dallas, TX 75224-3804

Mailing address

5822 Goldeneye LN
Dallas, TX 75249-2305

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260522001927 TX Practitioner - Nurse Practitioner 2365912078 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3436 S Polk St
Dallas, TX 75224-3804

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1228656TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Polk Medical Clinic LLC CurrentSince May 28, 2026 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1772668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772668800000",
    "number": "1205782117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5822 GOLDENEYE LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752492305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3436 S POLK ST STE A",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752243804",
            "telephone_number": "214-372-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS-COOK",
        "first_name": "BREONNA",
        "middle_name": "CHANTE",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-03-05",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1228656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.