Provider Demographics
NPI:1083101349
Name:COOPER-TRIPP, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:COOPER-TRIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2249
Mailing Address - Country:US
Mailing Address - Phone:860-274-2418
Mailing Address - Fax:860-274-2986
Practice Address - Street 1:365 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2249
Practice Address - Country:US
Practice Address - Phone:860-274-2418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-21
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT085878163W00000X
CT7674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse