Provider Demographics
NPI:1598474157
Name:COOPER-RAINEY, JOAN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:COOPER-RAINEY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HARDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-1727
Mailing Address - Country:US
Mailing Address - Phone:504-289-4420
Mailing Address - Fax:
Practice Address - Street 1:1111 MEDICAL CENTER BLVD STE N809
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3173
Practice Address - Country:US
Practice Address - Phone:504-289-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA228034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily