Provider Demographics
NPI:1841739638
Name:COOPER, MELVIN L JR (AG-ACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:L
Last Name:COOPER
Suffix:JR
Gender:M
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 W LOUIS HENNA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-1203
Mailing Address - Country:US
Mailing Address - Phone:512-492-3743
Mailing Address - Fax:512-593-4444
Practice Address - Street 1:1106 COLLEGE ST STE C
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3948
Practice Address - Country:US
Practice Address - Phone:512-244-2895
Practice Address - Fax:512-244-2895
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP133259363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care