Provider Demographics
NPI:1578502753
Name:COOPER, VERNON KENT (MD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:KENT
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WOODLEIGH DR S
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-3723
Mailing Address - Country:US
Mailing Address - Phone:417-699-0922
Mailing Address - Fax:
Practice Address - Street 1:800 S ASH ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3223
Practice Address - Country:US
Practice Address - Phone:417-448-3642
Practice Address - Fax:417-448-3641
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1028252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
206429OtherBCBS
MO206698102Medicaid
P00310772OtherRAILROAD MEDICARE
MO206698102Medicaid
956813603Medicare PIN