Provider Demographics
NPI:1124889977
Name:COOPER, JASMINE L
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 W MCMICKEN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45225-2326
Mailing Address - Country:US
Mailing Address - Phone:513-814-2502
Mailing Address - Fax:
Practice Address - Street 1:9025 MANDEL DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-3806
Practice Address - Country:US
Practice Address - Phone:513-814-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant