Provider Demographics
NPI:1891237871
Name:SIMPSON, COOPER (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:COOPER
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 S MIDDLETON RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651
Practice Address - Country:US
Practice Address - Phone:208-505-2800
Practice Address - Fax:208-505-2801
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDGPA-075363A00000X
IDPA-2111363A00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101Y00000XBehavioral Health & Social Service ProvidersCounselor