Provider Demographics
NPI:1083425615
Name:COOPER, JACOB (ARNP, AGNP-C)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:COOPER
Suffix:
Gender:
Credentials:ARNP, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NE 23RD CT
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-1225
Mailing Address - Country:US
Mailing Address - Phone:515-360-5451
Mailing Address - Fax:
Practice Address - Street 1:2720 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1050
Practice Address - Country:US
Practice Address - Phone:515-967-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1083425615363LP2300X, 363LF0000X
IA161373163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse