Provider Demographics
NPI:1356969927
Name:COOPER, DIANA LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYNN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:700 OAKMOUND RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-9398
Mailing Address - Country:US
Mailing Address - Phone:304-623-6330
Mailing Address - Fax:
Practice Address - Street 1:700 OAKMOUND RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-9398
Practice Address - Country:US
Practice Address - Phone:304-623-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV105664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily