Provider Demographics
NPI:1790750545
Name:COOPER, TRENT (NP)
Entity Type:Individual
Prefix:MR
First Name:TRENT
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26702 STAGECOACH CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-2198
Mailing Address - Country:US
Mailing Address - Phone:832-515-6872
Mailing Address - Fax:832-460-2865
Practice Address - Street 1:7460 WARREN PKWY
Practice Address - Street 2:160
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4169
Practice Address - Country:US
Practice Address - Phone:972-668-5400
Practice Address - Fax:972-668-5401
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX666237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1519134-09Medicaid
TX2035487-02Medicaid
TX8846B7Medicare ID - Type Unspecified
TX1519134-09Medicaid
TX2035487-02Medicaid
TXP63425Medicare UPIN