Provider Demographics
NPI:1891108775
Name:COOPER, KENYA A (MD)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:A
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KENYA
Other - Middle Name:
Other - Last Name:GOINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4080 AUGUSTA HWY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:SC
Practice Address - Zip Code:29054-8893
Practice Address - Country:US
Practice Address - Phone:803-892-1800
Practice Address - Fax:803-892-1812
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine