Provider Demographics
NPI:1396011912
Name:COOPER, KIMBERLY ANN (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:COOPER
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:PO BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-692-5800
Mailing Address - Fax:325-695-6111
Practice Address - Street 1:6300 REGIONAL PLZ
Practice Address - Street 2:SUITE 650
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5251
Practice Address - Country:US
Practice Address - Phone:325-695-5800
Practice Address - Fax:325-695-6111
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX641184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily