Provider Demographics
NPI:1629428081
Name:COOLEY, AMY KATHLEEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KATHLEEN
Last Name:COOLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:LYNN
Other - Last Name:COOLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:14146 SAGE TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1975
Mailing Address - Country:US
Mailing Address - Phone:210-322-0191
Mailing Address - Fax:
Practice Address - Street 1:14146 SAGE TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1975
Practice Address - Country:US
Practice Address - Phone:210-322-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities