Provider Demographics
NPI:1629492863
Name:COOPER, COMFORT KUMGBA (BA)
Entity Type:Individual
Prefix:MRS
First Name:COMFORT
Middle Name:KUMGBA
Last Name:COOPER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:COMFORT
Other - Middle Name:NYENETUE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:8529 HURST CT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-4402
Mailing Address - Country:US
Mailing Address - Phone:405-889-9650
Mailing Address - Fax:
Practice Address - Street 1:8529 HURST CT
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-4402
Practice Address - Country:US
Practice Address - Phone:405-889-9650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management