Provider Demographics
NPI:1912407750
Name:COOPER, KRISTIANNA WILDE (APRN, RN, FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTIANNA
Middle Name:WILDE
Last Name:COOPER
Suffix:
Gender:F
Credentials:APRN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 MEDICAL DISTRICT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7701
Mailing Address - Country:US
Mailing Address - Phone:844-483-5363
Mailing Address - Fax:214-456-6866
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:844-483-5363
Practice Address - Fax:214-456-6866
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX818009163WE0003X
TXAP136753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP136753OtherAPRN