Provider Demographics
NPI:1083310825
Name:COOPER, OLEXOUS L
Entity Type:Individual
Prefix:
First Name:OLEXOUS
Middle Name:L
Last Name:COOPER
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 1:114 NELSON DR
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-3212
Mailing Address - Country:US
Mailing Address - Phone:601-559-7160
Mailing Address - Fax:
Practice Address - Street 1:114 NELSON DR
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-3212
Practice Address - Country:US
Practice Address - Phone:601-559-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide