Basic Information
| Provider Information | |||||||||
| NPI: | 1780328575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22395 CLARK DR | ||||||||
| Address2: | |||||||||
| City: | MEADVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 646598229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6602475206 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2525 GLENN HENDREN DR | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640689625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167927000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2022 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | 2012002944 | MO | N | Nursing Service Providers | Registered Nurse | Emergency | 363LF0000X | 2022018935 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.