Provider Demographics
NPI:1568780419
Name:COOLEY, JILL STEPHANIE (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:STEPHANIE
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 DIANA DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4928
Mailing Address - Country:US
Mailing Address - Phone:336-577-6799
Mailing Address - Fax:
Practice Address - Street 1:3 DIANA DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4928
Practice Address - Country:US
Practice Address - Phone:336-577-6799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-16
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH124185207L00000X
TN53633207L00000X
390200000X
IN01086752A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program