Provider Demographics
NPI:1164621751
Name:COOPER, JACQUELINE (FNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4018 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2749
Mailing Address - Country:US
Mailing Address - Phone:504-897-9200
Mailing Address - Fax:504-897-9234
Practice Address - Street 1:4018 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2749
Practice Address - Country:US
Practice Address - Phone:504-897-9200
Practice Address - Fax:504-897-9234
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP02576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily