Healthcare Provider Details

I. General information

NPI: 1801502919
Provider Name (Legal Business Name): LINDA KAY COOGAN RN, NC-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 WIXFORD WAY
ALABASTER AL
35007-3156
US

IV. Provider business mailing address

PO BOX 1992
PELHAM AL
35124-5992
US

V. Phone/Fax

Practice location:
  • Phone: 205-370-4886
  • Fax:
Mailing address:
  • Phone: 205-370-4886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-052790
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number3683
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: