Provider Demographics
NPI:1689803272
Name:COOPER, ANGELIA VONCEIL (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:VONCEIL
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANGELIA
Other - Middle Name:VONCEIL
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2673
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-2673
Mailing Address - Country:US
Mailing Address - Phone:318-322-9252
Mailing Address - Fax:318-322-2885
Practice Address - Street 1:2933 CYPRESS ST
Practice Address - Street 2:SUITE # 1
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5337
Practice Address - Country:US
Practice Address - Phone:318-322-9252
Practice Address - Fax:318-322-2885
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2321099Medicaid
AZ433061Medicaid
031824Medicare Oscar/Certification
Z21115Medicare PIN
AZ433061Medicaid
031822Medicare Oscar/Certification
031806Medicare Oscar/Certification
031805Medicare Oscar/Certification
Z21130Medicare PIN
Z21114Medicare PIN
031823Medicare Oscar/Certification
Z21116Medicare PIN
Z21113Medicare PIN