Provider Demographics
NPI:1275043937
Name:COOPER, ASHLEIGH MARIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEIGH
Middle Name:MARIE
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ASHLEIGH
Other - Middle Name:MARIE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:5520 ROBINWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MANITOU BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:49253-9630
Mailing Address - Country:US
Mailing Address - Phone:419-205-1733
Mailing Address - Fax:
Practice Address - Street 1:5640 N ADRIAN HWY
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8318
Practice Address - Country:US
Practice Address - Phone:517-577-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704326520363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner