Provider Demographics
NPI:1457009342
Name:COOPER, STEPHANIE REHER (PNP)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:REHER
Last Name:COOPER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-635-3200
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:13700 PRIDE PORT HUDSON RD
Practice Address - Street 2:
Practice Address - City:PRIDE
Practice Address - State:LA
Practice Address - Zip Code:70770-9200
Practice Address - Country:US
Practice Address - Phone:225-654-7325
Practice Address - Fax:225-570-2043
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA224313363LP0200X, 363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA224313OtherSTATE LICENSE