Provider Demographics
NPI:1851697197
Name:COOPER, JACLYN J (APN)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:J
Last Name:COOPER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:J
Other - Last Name:FIKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 N SHACKLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2840
Mailing Address - Country:US
Mailing Address - Phone:501-712-2571
Mailing Address - Fax:
Practice Address - Street 1:2425 DAVE WARD DR
Practice Address - Street 2:SUITE 601
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8686
Practice Address - Country:US
Practice Address - Phone:501-773-6993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily