Provider Demographics
NPI:1568806909
Name:COOPER, LERONICA JAM'ES
Entity Type:Individual
Prefix:MS
First Name:LERONICA
Middle Name:JAM'ES
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 1:1718 COUNTRY PLACE CT
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-3665
Mailing Address - Country:US
Mailing Address - Phone:573-253-3252
Mailing Address - Fax:
Practice Address - Street 1:1718 COUNTRY PLACE CT
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3665
Practice Address - Country:US
Practice Address - Phone:573-253-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-27
Last Update Date:2013-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006032265164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006032265OtherMISSOURI STATE BOARD OF NURSING