Provider Demographics
NPI:1063556389
Name:COOPER, ADAM C (APN, RNC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:C
Last Name:COOPER
Suffix:
Gender:M
Credentials:APN, RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5454
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-5441
Mailing Address - Country:US
Mailing Address - Phone:423-569-3383
Mailing Address - Fax:423-569-2901
Practice Address - Street 1:133 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-2023
Practice Address - Country:US
Practice Address - Phone:423-569-7979
Practice Address - Fax:423-569-2901
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN111375163WP0808X
TNAPN0000012824363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health