Provider Demographics
NPI:1912968330
Name:COOPER, KAREN (ARNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 NW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-4340
Mailing Address - Country:US
Mailing Address - Phone:863-462-5784
Mailing Address - Fax:863-462-5219
Practice Address - Street 1:1728 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-4340
Practice Address - Country:US
Practice Address - Phone:863-462-5784
Practice Address - Fax:863-462-5219
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1432472363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034515600Medicaid