Provider Demographics
NPI:1770599284
Name:COOPER, MELISA DAWN (MMS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:DAWN
Last Name:COOPER
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:
Other - Last Name:FUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2326
Mailing Address - Country:US
Mailing Address - Phone:620-241-7400
Mailing Address - Fax:620-798-2613
Practice Address - Street 1:1000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2326
Practice Address - Country:US
Practice Address - Phone:620-241-7400
Practice Address - Fax:620-798-2613
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P91318Medicare UPIN
KS426740Medicare ID - Type Unspecified
P91318Medicare UPIN
KS100458300BMedicaid
KSP00166472OtherRAILROAD MEDICARE