Provider Demographics
NPI:1205452240
Name:COOPER, CIARRA
Entity type:Individual
Prefix:
First Name:CIARRA
Middle Name:
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 1:7828 PAT BOOKER RD APT 436
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2628
Mailing Address - Country:US
Mailing Address - Phone:386-690-4311
Mailing Address - Fax:
Practice Address - Street 1:133 WINDY MEADOWS DR STE 101
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1543
Practice Address - Country:US
Practice Address - Phone:210-447-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19105841374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician