Provider Demographics
NPI:1700519147
Name:COOPER, GABRIELLE MICHELE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MICHELE
Last Name:COOPER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 GREEN SHANTY RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9024
Mailing Address - Country:US
Mailing Address - Phone:423-322-5928
Mailing Address - Fax:
Practice Address - Street 1:2366 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4030
Practice Address - Country:US
Practice Address - Phone:706-452-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP000795363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics