Provider Demographics
NPI:1407995798
Name:COOPER, KATHRYN H (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:H
Last Name:COOPER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 COUNTY ROAD 378
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:AL
Mailing Address - Zip Code:35673-5346
Mailing Address - Country:US
Mailing Address - Phone:256-355-5169
Mailing Address - Fax:
Practice Address - Street 1:1874 BELTLINE RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5514
Practice Address - Country:US
Practice Address - Phone:256-301-3340
Practice Address - Fax:256-301-3443
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44289367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL042380OtherRN LICENSE
AL44289OtherCRNA LICENSE