Provider Demographics
NPI:1316946361
Name:COOPER, NANCY J (APRN-CNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:COOPER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 W RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3834
Mailing Address - Country:US
Mailing Address - Phone:580-599-0272
Mailing Address - Fax:580-603-8602
Practice Address - Street 1:822 W RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3834
Practice Address - Country:US
Practice Address - Phone:580-599-0272
Practice Address - Fax:580-603-8602
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0045211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200006240AMedicaid
$$$$$$$$$MMedicare PIN
OK200006240AMedicaid
S57660Medicare UPIN