Provider Demographics
NPI:1932739935
Name:COOPER, PAULA JEAN
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4828
Mailing Address - Country:US
Mailing Address - Phone:580-458-9117
Mailing Address - Fax:
Practice Address - Street 1:905 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4828
Practice Address - Country:US
Practice Address - Phone:580-458-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist