Provider Demographics
NPI:1265719520
Name:COOPER, JACQUELINE ROSE (RN, CNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ROSE
Last Name:COOPER
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 KLEIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-5800
Mailing Address - Country:US
Mailing Address - Phone:507-933-5001
Mailing Address - Fax:507-934-7043
Practice Address - Street 1:2000 KLEIN ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-5800
Practice Address - Country:US
Practice Address - Phone:507-933-5001
Practice Address - Fax:507-934-7043
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR204960-3363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health