Provider Demographics
NPI:1104159540
Name:COOPER, REBECCA LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:13741 NC HIGHWAY 50 STE A
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28445-6935
Mailing Address - Country:US
Mailing Address - Phone:910-777-2732
Mailing Address - Fax:910-777-2742
Practice Address - Street 1:13741 NC HIGHWAY 50 STE A
Practice Address - Street 2:
Practice Address - City:SURF CITY
Practice Address - State:NC
Practice Address - Zip Code:28445-6935
Practice Address - Country:US
Practice Address - Phone:910-777-2732
Practice Address - Fax:910-777-2742
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-03705363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical