Provider Demographics
NPI:1053331413
Name:COOPER, KATHRYN J (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:COOPER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2986 KATE BOND RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4003
Mailing Address - Country:US
Mailing Address - Phone:901-820-7750
Mailing Address - Fax:901-820-7712
Practice Address - Street 1:6263 POPLAR AVE
Practice Address - Street 2:SUITE 1032
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4701
Practice Address - Country:US
Practice Address - Phone:901-761-3255
Practice Address - Fax:901-761-3257
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK200088363LA2100X
TNAPN 12096363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care