Provider Demographics
NPI:1740746528
Name:COOPER, LISA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W SUNCHASE DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-7820
Mailing Address - Country:US
Mailing Address - Phone:817-715-1870
Mailing Address - Fax:
Practice Address - Street 1:411 N BELKNAP ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3415
Practice Address - Country:US
Practice Address - Phone:817-250-4906
Practice Address - Fax:817-250-4815
Is Sole Proprietor?:No
Enumeration Date:2019-02-16
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily