Provider Demographics
NPI:1306124854
Name:COOPER, PHILLIP ANDREW (CRNA)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ANDREW
Last Name:COOPER
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:3810 CENTRAL AVENUE
Mailing Address - Street 2:SUITE H
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6921
Mailing Address - Country:US
Mailing Address - Phone:501-525-5840
Mailing Address - Fax:501-525-1762
Practice Address - Street 1:300 WERNER STREET
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6921
Practice Address - Country:US
Practice Address - Phone:501-622-1875
Practice Address - Fax:501-622-1925
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARRNLICENSE#R79207163W00000X
ARCRNA#C02873367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse