Provider Demographics
NPI:1982942066
Name:COOPER, JORDAN BOND (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:BOND
Last Name:COOPER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11560 PENICK WAY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1796
Mailing Address - Country:US
Mailing Address - Phone:713-416-0218
Mailing Address - Fax:
Practice Address - Street 1:1737 BRIARCREST DR
Practice Address - Street 2:SUITE 14
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2769
Practice Address - Country:US
Practice Address - Phone:979-776-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX754677367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered