Provider Demographics
NPI:1124784293
Name:COOPER, CATHARINE ELAINE (NP)
Entity type:Individual
Prefix:
First Name:CATHARINE
Middle Name:ELAINE
Last Name:COOPER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 SW PHEASANT TRL
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-1550
Mailing Address - Country:US
Mailing Address - Phone:281-253-1482
Mailing Address - Fax:
Practice Address - Street 1:2304 SW PHEASANT TRL
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-1550
Practice Address - Country:US
Practice Address - Phone:281-253-1482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80651-092363LA2200X
MO2021042810363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health