Basic Information
| Provider Information | |||||||||
| NPI: | 1841739638 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | MELVIN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | AG-ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4515 SETON CENTER PKWY | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787595290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123244083 | ||||||||
| FaxNumber: | 5124067398 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 MEDICAL PKWY | ||||||||
| Address2: | |||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786137763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123244083 | ||||||||
| FaxNumber: | 5124067398 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2017 | ||||||||
| LastUpdateDate: | 02/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | AP133259 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.