Provider Demographics
NPI:1093786451
Name:COOPER, WILLIAM T (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:COOPER
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:1515 W TRUMAN RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-3436
Mailing Address - Country:US
Mailing Address - Phone:816-461-3131
Mailing Address - Fax:816-461-1662
Practice Address - Street 1:1515 W TRUMAN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-3436
Practice Address - Country:US
Practice Address - Phone:816-461-3131
Practice Address - Fax:816-461-1662
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2019-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO1318997367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO913553202Medicaid