Provider Demographics
NPI:1689052383
Name:COOPER, KEISHA NICOLE (MS)
Entity Type:Individual
Prefix:MS
First Name:KEISHA
Middle Name:NICOLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BALA AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3202
Mailing Address - Country:US
Mailing Address - Phone:844-275-8716
Mailing Address - Fax:484-483-4831
Practice Address - Street 1:19 BALA AVE STE 302
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3202
Practice Address - Country:US
Practice Address - Phone:844-275-8716
Practice Address - Fax:484-483-4831
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator