Provider Demographics
NPI:1336684109
Name:COOPER, SANDRA L (APRN, CNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:APRN, CNP, FNP-C
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:DOWNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3515 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0711
Mailing Address - Country:US
Mailing Address - Phone:903-831-7270
Mailing Address - Fax:903-793-0496
Practice Address - Street 1:14321 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8624
Practice Address - Country:US
Practice Address - Phone:405-342-0255
Practice Address - Fax:405-610-6960
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK83522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily