Provider Demographics
NPI:1912721903
Name:COOPER, AMBER (APRN-NP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1076
Mailing Address - Street 2:
Mailing Address - City:MERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97532-1076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1076
Practice Address - Street 2:
Practice Address - City:MERLIN
Practice Address - State:OR
Practice Address - Zip Code:97532-1076
Practice Address - Country:US
Practice Address - Phone:541-415-4904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10035337363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty