Basic Information
| Provider Information | |||||||||
| NPI: | 1962894196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOPER | ||||||||
| FirstName: | BRANDY | ||||||||
| MiddleName: | NACOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN-CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2309 | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735022309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803579984 | ||||||||
| FaxNumber: | 5803573277 | ||||||||
| Practice Location | |||||||||
| Address1: | 7936 US HIGHWAY 277 | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735382144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804926900 | ||||||||
| FaxNumber: | 5804926902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2015 | ||||||||
| LastUpdateDate: | 07/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0090348 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.