Provider Demographics
NPI:1861512154
Name:COOPER, PAMELA R (BS)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:COOPER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 WOOTEN LN
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-7433
Mailing Address - Country:US
Mailing Address - Phone:405-372-0638
Mailing Address - Fax:
Practice Address - Street 1:712 DEVON ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-1926
Practice Address - Country:US
Practice Address - Phone:405-372-6100
Practice Address - Fax:405-624-7516
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator