Provider Demographics
NPI:1851676308
Name:COOPER ADVANCED PRACTICE
Entity Type:Organization
Organization Name:COOPER ADVANCED PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:936-242-9809
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:936-242-9809
Mailing Address - Fax:832-460-2685
Practice Address - Street 1:18230 FM 1488 RD
Practice Address - Street 2:SUITE 328
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4528
Practice Address - Country:US
Practice Address - Phone:936-242-9809
Practice Address - Fax:832-460-2685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX666237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty