Provider Demographics
NPI:1598098329
Name:COOPER, JESSICA (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:FURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CPNP
Mailing Address - Street 1:5 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1917
Mailing Address - Country:US
Mailing Address - Phone:860-778-8406
Mailing Address - Fax:
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-545-9520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4195363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics