Provider Demographics
NPI:1851379887
Name:COOMER, CATHERINE (ARNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:COOMER
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 SUNSHINE LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-6750
Mailing Address - Country:US
Mailing Address - Phone:812-725-0502
Mailing Address - Fax:
Practice Address - Street 1:9431 HIGHWAY 403
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-8946
Practice Address - Country:US
Practice Address - Phone:812-256-6391
Practice Address - Fax:812-256-6050
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4130P363LF0000X
IN71002616A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013059Medicaid
0000000316850OtherANTHEM
KY7197539OtherAETNA
KY78013059Medicaid
KY7197539OtherAETNA