Provider Demographics
NPI:1235828252
Name:COOLEY, DAVID WAYNE JR (CNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:COOLEY
Suffix:JR
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:TX
Mailing Address - Zip Code:77359-0054
Mailing Address - Country:US
Mailing Address - Phone:281-309-2587
Mailing Address - Fax:
Practice Address - Street 1:28 OLD DODGE RD
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:TX
Practice Address - Zip Code:77359-1412
Practice Address - Country:US
Practice Address - Phone:281-309-2587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA006003466385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No385H00000XRespite Care FacilityRespite Care