Provider Demographics
NPI:1376167486
Name:COOLEY, JENNIFER L (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 N. PIEDRAS ST
Mailing Address - Street 2:ATTN: MCHM-DOS-GSR
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-2698
Mailing Address - Fax:915-742-7889
Practice Address - Street 1:5005 N. PIEDRAS ST
Practice Address - Street 2:ATTN: MCHM-DOS-GSR
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-742-2698
Practice Address - Fax:915-742-7889
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program