Provider Demographics
NPI:1154463925
Name:COOLEY, BRETT ALAN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:ALAN
Last Name:COOLEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 122431
Mailing Address - Street 2:DEPT 2431
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2431
Mailing Address - Country:US
Mailing Address - Phone:337-480-8900
Mailing Address - Fax:337-480-8901
Practice Address - Street 1:4150 NELSON RD
Practice Address - Street 2:A4 ANESTHESIA ASSOCIATES
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-474-6353
Practice Address - Fax:337-477-7616
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP01717367500000X
LARN065292367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1651494Medicaid
LA5T557Medicare ID - Type Unspecified
R70404Medicare UPIN