Provider Demographics
NPI:1477872273
Name:COOPER, TONI L (RN, MSN, CDE)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:RN, MSN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 RIVER OAKS DR
Mailing Address - Street 2:STE. 302
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9530
Mailing Address - Country:US
Mailing Address - Phone:601-939-9923
Mailing Address - Fax:601-939-9924
Practice Address - Street 1:1040 RIVER OAKS DR
Practice Address - Street 2:STE. 302
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39232-9530
Practice Address - Country:US
Practice Address - Phone:601-939-9923
Practice Address - Fax:601-939-9924
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR501069163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR501069OtherLICENSE NUMBER