Provider Demographics
NPI:1689457251
Name:COOPER, JAELYN SIMONE
Entity Type:Individual
Prefix:
First Name:JAELYN
Middle Name:SIMONE
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 1:6410 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016-2005
Mailing Address - Country:US
Mailing Address - Phone:346-400-8184
Mailing Address - Fax:
Practice Address - Street 1:905 DUNSON GLEN DR APT D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-7024
Practice Address - Country:US
Practice Address - Phone:346-400-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula