Provider Demographics
NPI:1164644167
Name:COOPER, BRENDA JOYCE (RN)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JOYCE
Last Name:COOPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:JOYCE
Other - Last Name:COOPER-GOEBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5844 VICKERY BLVD
Mailing Address - Street 2:APT A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206
Mailing Address - Country:US
Mailing Address - Phone:912-220-5320
Mailing Address - Fax:
Practice Address - Street 1:2535 LONE STAR DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212
Practice Address - Country:US
Practice Address - Phone:469-533-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX695156163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse