Provider Demographics
NPI:1326061482
Name:COOPER, PENELOPE VERNON (FNP-C DNP)
Entity Type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:VERNON
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP-C DNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:245 MEDICAL PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-1100
Mailing Address - Country:US
Mailing Address - Phone:276-378-3300
Mailing Address - Fax:276-378-1265
Practice Address - Street 1:245 MEDICAL PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-1100
Practice Address - Country:US
Practice Address - Phone:276-378-3300
Practice Address - Fax:276-378-1265
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024166391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326061482Medicaid
VA010390532Medicaid
VA1326061482Medicaid
VA010390532Medicaid