Provider Demographics
NPI:1659135994
Name:COOPER, KINSLEY SHARLA
Entity Type:Individual
Prefix:
First Name:KINSLEY
Middle Name:SHARLA
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48642 871ST RD
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-4679
Mailing Address - Country:US
Mailing Address - Phone:402-992-4417
Mailing Address - Fax:
Practice Address - Street 1:48642 871ST RD
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-4679
Practice Address - Country:US
Practice Address - Phone:402-992-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician