Provider Demographics
NPI:1609995612
Name:COOPER, TERESA MAY (FNP-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MAY
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MAY
Other - Last Name:HOLCOMBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1051 LIPAN APACHE RUN
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-6210
Mailing Address - Country:US
Mailing Address - Phone:512-422-6679
Mailing Address - Fax:
Practice Address - Street 1:5211 FM 2920 RD STE 101
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3004
Practice Address - Country:US
Practice Address - Phone:281-783-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4965363LF0000X
NMCNP-01562363LF0000X
TXAP112436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y4019OtherBCBS PVN
TX8L8541Medicare PIN
TX8Y4019OtherBCBS PVN
TX8K3181Medicare PIN