MEDICARE: MR. MELVIN L COOPER JR. AG-ACNP-BC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	AP133259	TX
2	363L00000X	Nurse Practitioner	AP133259	TX

General Provider Information

NPI Number	:	1841739638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MELVIN L COOPER JR. AG-ACNP-BC

Provider Business Mailing Address
First Line	:	101 W LOUIS HENNA BLVD STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78728-1203
Country	:	US
Telephone Number	:	512-492-3743
Fax Number	:	512-593-4444

Provider Business Practice Location Address
First Line	:	1106 COLLEGE ST STE C
Second Line	:
City	:	BASTROP
State	:	TX
Zip	:	78602-3948
Country	:	US
Telephone Number	:	512-244-2895
Fax Number	:	512-244-2895

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

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	08/18/2023

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Directions to “ MR. MELVIN L COOPER JR. AG-ACNP-BC” Practice Location

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