Provider Demographics
NPI:1194237172
Name:COOPER, KATHRYN CAMILLE (FNP)
Entity type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:CAMILLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:477 N EL CAMINO REAL STE A100
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1329
Mailing Address - Country:US
Mailing Address - Phone:760-943-9111
Mailing Address - Fax:760-943-0180
Practice Address - Street 1:477 N EL CAMINO REAL STE A100
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1329
Practice Address - Country:US
Practice Address - Phone:760-943-9111
Practice Address - Fax:760-943-0180
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF95006930363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care