Provider Demographics
NPI:1376319616
Name:COOLEY, REGINA DAWN
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:DAWN
Last Name:COOLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-1045
Mailing Address - Country:US
Mailing Address - Phone:681-733-0260
Mailing Address - Fax:
Practice Address - Street 1:287 3RD ST W
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1045
Practice Address - Country:US
Practice Address - Phone:681-733-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant