Provider Demographics
NPI:1932533544
Name:COOPER, KRISTIN C (PRSS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:C
Last Name:COOPER
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:C
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6604
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25362-0604
Mailing Address - Country:US
Mailing Address - Phone:304-400-2100
Mailing Address - Fax:
Practice Address - Street 1:2 JARRETT CT APT A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2223
Practice Address - Country:US
Practice Address - Phone:304-400-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist