Provider Demographics
NPI:1689900466
Name:COOPER, BRYAN KENT (DNP, MSN, ARNP, NP-C)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:KENT
Last Name:COOPER
Suffix:
Gender:M
Credentials:DNP, MSN, ARNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 ELGER BAY RD
Mailing Address - Street 2:
Mailing Address - City:CAMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282-8375
Mailing Address - Country:US
Mailing Address - Phone:603-572-2202
Mailing Address - Fax:603-572-2232
Practice Address - Street 1:1283 ELGER BAY RD
Practice Address - Street 2:
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282-8375
Practice Address - Country:US
Practice Address - Phone:603-572-2202
Practice Address - Fax:360-572-2232
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60022308163W00000X
WAAP60116875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse