Provider Demographics
NPI:1669727616
Name:COOLEY, NICOLE ANN
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANN
Last Name:COOLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:ANN
Other - Last Name:COOLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10900 STADIUM PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66111-8100
Mailing Address - Country:US
Mailing Address - Phone:913-905-0317
Mailing Address - Fax:013-553-6333
Practice Address - Street 1:10900 STADIUM PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66111-8100
Practice Address - Country:US
Practice Address - Phone:913-905-0317
Practice Address - Fax:913-553-6333
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012025393183500000X
KS1-15354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist