Provider Demographics
NPI:1437359601
Name:COOPER, SHELBI DAWN (FNP)
Entity Type:Individual
Prefix:
First Name:SHELBI
Middle Name:DAWN
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 1:316 KYLIE CT
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-6633
Mailing Address - Country:US
Mailing Address - Phone:903-335-8860
Mailing Address - Fax:903-335-8739
Practice Address - Street 1:719 W COKE RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3011
Practice Address - Country:US
Practice Address - Phone:903-342-3781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX698233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200436801Medicaid
TX811N02OtherBCBS BILLING NUMBER
TXTIN PLUS 020OtherTRICARE
TX895N69OtherBCBS
TX752771569005OtherTRICARE
TX200436801Medicaid
TX270854YN3XMedicare PIN
TX811N02OtherBCBS BILLING NUMBER