Provider Demographics
NPI:1801926001
Name:COOPER, KIRSTEN LEA (MD)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LEA
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13220 STARKEY RD STE 500
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-1446
Mailing Address - Country:US
Mailing Address - Phone:727-398-7701
Mailing Address - Fax:727-287-4541
Practice Address - Street 1:13220 STARKEY RD STE 500
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1446
Practice Address - Country:US
Practice Address - Phone:727-398-7701
Practice Address - Fax:727-287-4541
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139523207Q00000X
KY33166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2075768OtherCCN FIRST HEALTH
KY5276688OtherAETNA
FL102656300Medicaid
KY1224232OtherCHA
KY64331663Medicaid
KY84146OtherWASAU
KY84146OtherWASAU
KY0169Medicare PIN
KY1224232OtherCHA