Provider Demographics
NPI:1558635482
Name:COOPER, KATHLEEN K (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:K
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1869 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4625
Mailing Address - Country:US
Mailing Address - Phone:631-574-2580
Mailing Address - Fax:631-574-2585
Practice Address - Street 1:450 CLARKSON AVE # 22
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:631-734-8286
Practice Address - Fax:631-734-8286
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY33 330164NY363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily