Provider Demographics
NPI:1679794069
Name:COOPER, TAKESHA JENENE (MD)
Entity Type:Individual
Prefix:DR
First Name:TAKESHA
Middle Name:JENENE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAKESHA
Other - Middle Name:JENENE
Other - Last Name:VALENTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5190 NEIL RD STE 215
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6509
Mailing Address - Country:US
Mailing Address - Phone:775-982-7800
Mailing Address - Fax:775-982-8043
Practice Address - Street 1:5190 NEIL RD STE 215
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6509
Practice Address - Country:US
Practice Address - Phone:775-982-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA881992084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A881990Medicaid
CA00A881990Medicare PIN
CA00A881990Medicaid