Provider Demographics
NPI:1427335348
Name:COOPER, SCOTT ALLEN (PA-C)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALLEN
Last Name:COOPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 12TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401
Mailing Address - Country:US
Mailing Address - Phone:580-798-4122
Mailing Address - Fax:580-405-2048
Practice Address - Street 1:1420 12TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-798-4122
Practice Address - Fax:580-405-2048
Is Sole Proprietor?:No
Enumeration Date:2011-11-06
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60779055363AM0700X
CA55258363AM0700X
MTMED-PAC-LIC-60682363AM0700X
AK126935363AM0700X
ARPA-1286363AM0700X
OK2044363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical