Provider Demographics
NPI:1417212168
Name:COOPER, EMILY KING (FNP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:KING
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:270 E COURT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-2304
Mailing Address - Country:US
Mailing Address - Phone:731-645-7932
Mailing Address - Fax:731-645-5195
Practice Address - Street 1:270 E COURT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-2304
Practice Address - Country:US
Practice Address - Phone:731-645-7932
Practice Address - Fax:731-645-5195
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16765363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner