Provider Demographics
NPI:1326783440
Name:PAGE, MARIA COOPER (FNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:COOPER
Last Name:PAGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 HIGHWAY 45 ALT S
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-0414
Mailing Address - Country:US
Mailing Address - Phone:662-854-9012
Mailing Address - Fax:662-854-9013
Practice Address - Street 1:5713 HIGHWAY 45 ALT S
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-0414
Practice Address - Country:US
Practice Address - Phone:662-854-9012
Practice Address - Fax:662-854-9013
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty