Kahlilah Cooke, RN, BS, CLC

Key facts

NPI

1316744832

Entity type

Individual (NPI type 1)

Primary specialty

Lactation Consultant (Registered Nurse) 163WL0100X

License

041498666 (IL)

Practice address

4116 Fieldstone Rd
Champaign, IL 61822-8801

Phone

(217) 902-3140

NPI assigned

Mar 3, 2025

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Bachelor of Science, Registered Nurse

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 3, 2025.

{
    "created_epoch": "1740960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1316744832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4116 FIELDSTONE RD",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618228801",
            "telephone_number": "217-902-3140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOKE",
        "first_name": "KAHLILAH",
        "credential": "RN, BS, CLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-03",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "IL",
            "license": "041498666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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