Provider Demographics
NPI:1184381030
Name:COOPER, JORDAN ALEXANDER (DNP, RN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ALEXANDER
Last Name:COOPER
Suffix:
Gender:
Credentials:DNP, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 HEATHER TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1215
Mailing Address - Country:US
Mailing Address - Phone:314-724-6084
Mailing Address - Fax:
Practice Address - Street 1:3522 HEATHER TRAILS DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-1215
Practice Address - Country:US
Practice Address - Phone:314-724-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021025674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily