Provider Demographics
NPI:1215002498
Name:DIVERSIFIED NURSING SERVICES, INC.
Entity Type:Organization
Organization Name:DIVERSIFIED NURSING SERVICES, INC.
Other - Org Name:LISA B. COOPER, CFNP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:662-251-4055
Mailing Address - Street 1:770 N WOLFE RD
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MS
Mailing Address - Zip Code:39740-9763
Mailing Address - Country:US
Mailing Address - Phone:662-251-4055
Mailing Address - Fax:662-304-4002
Practice Address - Street 1:505 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-3349
Practice Address - Country:US
Practice Address - Phone:662-369-6431
Practice Address - Fax:662-369-6473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR826442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty