Provider Demographics
NPI:1922580018
Name:COOPER, KENYA K
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:K
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENYA
Other - Middle Name:K
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2746 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-3357
Mailing Address - Country:US
Mailing Address - Phone:810-525-5222
Mailing Address - Fax:
Practice Address - Street 1:2746 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-3357
Practice Address - Country:US
Practice Address - Phone:810-525-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI83-1760934374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI83-1760934OtherHOME HEALTH CARE