Provider Demographics
NPI:1710538012
Name:COOPER, KATHERINE MILLER (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MILLER
Last Name:COOPER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 N TRINNAMAN LN
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3535
Mailing Address - Country:US
Mailing Address - Phone:801-436-4198
Mailing Address - Fax:
Practice Address - Street 1:1708 N TRINNAMAN LN
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-3535
Practice Address - Country:US
Practice Address - Phone:801-436-4198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8576587-3102163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult