Provider Demographics
NPI:1003138678
Name:COOLEY, JUDITH L (CRNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:COOLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 22ND ST S STE 1000
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2881
Mailing Address - Country:US
Mailing Address - Phone:469-893-2065
Mailing Address - Fax:469-893-3065
Practice Address - Street 1:430 FIELDSTOWN RD STE 104
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071
Practice Address - Country:US
Practice Address - Phone:205-631-5521
Practice Address - Fax:205-631-5540
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-048423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily