MEDICARE: PATRICIA A COOPER DNP, MSN, APRN

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	3398P	KY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00298919	OTHER	KY	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12397376	OTHER		MULTIPLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000384144	OTHER		ANTHEM
4	3398P	OTHER	KY	LICENSE NO
5	9408613	OTHER		PHCS
6	1226724	OTHER		CHA

NPI Number	:	1831177534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA A COOPER DNP, MSN, APRN

Provider Business Mailing Address
First Line	:	305 LANGDON ST
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42503-2750
Country	:	US
Telephone Number	:	606-678-3531
Fax Number	:	606-451-2641

Provider Business Practice Location Address
First Line	:	305 LANGDON ST
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42503-2750
Country	:	US
Telephone Number	:	606-678-3531
Fax Number	:	606-451-2641

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	06/28/2013

301 LANGDON ST
SOMERSET, KY
42503-2750

Practice Phone: 606-678-9688
Practice Fax: 606-679-7479