Provider Demographics
NPI:1942947908
Name:COOPER, CHERYL B
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:B
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 BRUSH RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-5535
Mailing Address - Country:US
Mailing Address - Phone:304-520-6306
Mailing Address - Fax:
Practice Address - Street 1:1199 BRUSH RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-5535
Practice Address - Country:US
Practice Address - Phone:304-520-6306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant