Basic Information
| Provider Information | |||||||||
| NPI: | 1093176539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | JOANNE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 N PROGRESS DR | ||||||||
| Address2: | |||||||||
| City: | XENIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453852666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375622280 | ||||||||
| FaxNumber: | 9375622282 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 N PROGRESS DR | ||||||||
| Address2: | |||||||||
| City: | XENIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453852666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375622280 | ||||||||
| FaxNumber: | 9375622282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2016 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | COA.18716-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.