Provider Demographics
NPI:1467097394
Name:COOPER, IZETTA KATHY
Entity Type:Individual
Prefix:
First Name:IZETTA
Middle Name:KATHY
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SULGRAVE CT
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-4573
Mailing Address - Country:US
Mailing Address - Phone:304-279-9253
Mailing Address - Fax:
Practice Address - Street 1:200 SULGRAVE CT
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-4573
Practice Address - Country:US
Practice Address - Phone:304-279-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker