Provider Demographics
NPI:1275099475
Name:COOPER, CASSIDY RAMSEY (PA-C)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:RAMSEY
Last Name:COOPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:PAIGE
Other - Last Name:RAMSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:AR
Mailing Address - Zip Code:72020-9151
Mailing Address - Country:US
Mailing Address - Phone:501-344-8800
Mailing Address - Fax:
Practice Address - Street 1:504 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:AR
Practice Address - Zip Code:72020-9151
Practice Address - Country:US
Practice Address - Phone:501-344-8800
Practice Address - Fax:501-344-8805
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2019-013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant