Provider Demographics
NPI:1457525453
Name:COOLING, SARAH JORDAN (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JORDAN
Last Name:COOLING
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JORDAN
Other - Last Name:HAIRGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:2829 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7887
Mailing Address - Country:US
Mailing Address - Phone:337-477-7091
Mailing Address - Fax:337-474-4552
Practice Address - Street 1:2829 4TH AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7887
Practice Address - Country:US
Practice Address - Phone:337-477-7091
Practice Address - Fax:337-474-4552
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN086177363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1073261Medicaid
LA1073261Medicaid