Healthcare Provider Details

I. General information

NPI: 1639446271
Provider Name (Legal Business Name): MENDY COOPER MCCLELLAND PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MENDY NICOLE COOPER

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 HIGHWAY 64 W
BEEBE AR
72012-9500
US

IV. Provider business mailing address

47 HIGHWAY 64 W
BEEBE AR
72012-9500
US

V. Phone/Fax

Practice location:
  • Phone: 501-882-3388
  • Fax: 501-882-3300
Mailing address:
  • Phone: 501-882-3388
  • Fax: 501-882-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-471
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: