Provider Demographics
NPI:1104839844
Name:COOLEY, SYLVIA JEAN (RN, C-FNP)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:JEAN
Last Name:COOLEY
Suffix:
Gender:F
Credentials:RN, C-FNP
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Mailing Address - Street 1:3030 NORTH ST
Mailing Address - Street 2:SUITE 560
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1433
Mailing Address - Country:US
Mailing Address - Phone:409-835-9834
Mailing Address - Fax:409-835-7623
Practice Address - Street 1:3030 NORTH ST
Practice Address - Street 2:SUITE 560
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1433
Practice Address - Country:US
Practice Address - Phone:409-835-9834
Practice Address - Fax:409-835-7623
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N9702OtherBLUE CROSS & BLUE SHEILD
P81571Medicare UPIN
TX8G2209Medicare PIN