Provider Demographics
NPI:1447560248
Name:COOPER, PATSY ANN (FNP B C)
Entity Type:Individual
Prefix:
First Name:PATSY
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP B C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 A WILDLIFE LANE
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-2881
Mailing Address - Country:US
Mailing Address - Phone:907-543-2871
Mailing Address - Fax:
Practice Address - Street 1:631 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-1908
Practice Address - Country:US
Practice Address - Phone:907-543-3773
Practice Address - Fax:907-543-3545
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURU1126363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK92-0089260Medicaid
AK92-0089260Medicaid