Provider Demographics
NPI:1013743699
Name:COOPER, KENNIA SARAHI
Entity type:Individual
Prefix:
First Name:KENNIA
Middle Name:SARAHI
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 1:3121 BAKERTOWN STATION WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4072
Mailing Address - Country:US
Mailing Address - Phone:865-256-3955
Mailing Address - Fax:
Practice Address - Street 1:817 WESTCOTT LN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-5272
Practice Address - Country:US
Practice Address - Phone:615-243-0968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health