Provider Demographics
NPI:1629521281
Name:COOPER, ALYSON NICOLE (APRN-C)
Entity Type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:NICOLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026 BRADFORD GROVE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5711
Mailing Address - Country:US
Mailing Address - Phone:502-220-3949
Mailing Address - Fax:
Practice Address - Street 1:5929 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8132
Practice Address - Country:US
Practice Address - Phone:502-228-2507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily