Provider Demographics
NPI:1710695580
Name:HARPER, RAEANNA COONER (NP)
Entity Type:Individual
Prefix:MRS
First Name:RAEANNA
Middle Name:COONER
Last Name:HARPER
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 1:3641 SHANDWICK PL
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6418
Mailing Address - Country:US
Mailing Address - Phone:205-522-7473
Mailing Address - Fax:
Practice Address - Street 1:4100 GREYSTONE DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6409
Practice Address - Country:US
Practice Address - Phone:205-522-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-136270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherNO INSURANCE BILLING