Provider Demographics
NPI:1710176946
Name:COOLEY, KATHY NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:NICOLE
Last Name:COOLEY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:36115 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1216
Mailing Address - Country:US
Mailing Address - Phone:734-464-0887
Mailing Address - Fax:734-402-0254
Practice Address - Street 1:21409 KELLY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3264
Practice Address - Country:US
Practice Address - Phone:586-777-0630
Practice Address - Fax:586-777-0631
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2014-08-06
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Provider Licenses
StateLicense IDTaxonomies
MI5601004702363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant