Provider Demographics
NPI:1215046339
Name:COOPER, PANSY J (APRN)
Entity Type:Individual
Prefix:
First Name:PANSY
Middle Name:J
Last Name:COOPER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DOCTOR CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6502
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:
Practice Address - Street 1:241 SINGLETON RIDGE ROAD, SUITE B
Practice Address - Street 2:MAIN STREET PHYSICIANS
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:843-347-7232
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2336363LA2100X, 363LF0000X
SC2336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0452Medicaid
SCP00155306OtherMEDICARE RR
SCNP0452Medicaid