Provider Demographics
NPI:1669527834
Name:COOPER, RUTH DAIL (FNP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:DAIL
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1484 SUMMERLINS CROSSROAD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-8588
Mailing Address - Country:US
Mailing Address - Phone:919-658-9215
Mailing Address - Fax:
Practice Address - Street 1:340 SEMINARY ST
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349-0948
Practice Address - Country:US
Practice Address - Phone:910-296-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily