Provider Demographics
NPI:1891853354
Name:COOPER, PAUL BRANDON (APRN)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:BRANDON
Last Name:COOPER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 MEMORIAL CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-5004
Mailing Address - Country:US
Mailing Address - Phone:405-749-7099
Mailing Address - Fax:405-755-9237
Practice Address - Street 1:4505 MEMORIAL CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142
Practice Address - Country:US
Practice Address - Phone:405-749-7099
Practice Address - Fax:405-755-9237
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100353363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK246724002Medicare PIN