Provider Demographics
NPI:1770303737
Name:COOPER, ALICIA JEAN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:JEAN
Last Name:COOPER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 STORM BIRD LOOP
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2257
Mailing Address - Country:US
Mailing Address - Phone:757-619-4534
Mailing Address - Fax:
Practice Address - Street 1:5265 PROVIDENCE RD STE 500
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4210
Practice Address - Country:US
Practice Address - Phone:757-467-9500
Practice Address - Fax:757-467-9560
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2024068271363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health