Provider Demographics
NPI:1598356164
Name:COOPER, KASIE D (PA-C)
Entity Type:Individual
Prefix:
First Name:KASIE
Middle Name:D
Last Name:COOPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W 14TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3385
Mailing Address - Country:US
Mailing Address - Phone:402-272-5941
Mailing Address - Fax:
Practice Address - Street 1:40 W 14TH ST STE 3
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3385
Practice Address - Country:US
Practice Address - Phone:140-683-9189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT122910363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant