Provider Demographics
NPI:1831177534
Name:COOPER, PATRICIA A (DNP, MSN, APRN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:COOPER
Suffix:
Gender:F
Credentials:DNP, MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 LANGDON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2750
Mailing Address - Country:US
Mailing Address - Phone:606-678-3531
Mailing Address - Fax:606-451-2641
Practice Address - Street 1:305 LANGDON ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2750
Practice Address - Country:US
Practice Address - Phone:606-678-3531
Practice Address - Fax:606-451-2641
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3398P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
12397376OtherMULTIPLAN
KY78015567Medicaid
000000384144OtherANTHEM
KY3398POtherLICENSE NO
9408613OtherPHCS
1226724OtherCHA
KYP00298919OtherRAILROAD MEDICARE
P06013Medicare UPIN
KY78015567Medicaid