Healthcare Provider Details

I. General information

NPI: 1750215737
Provider Name (Legal Business Name): VASTER LESHAWN COOPER II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 W AVENUE B ST
HOPE AR
71801-8451
US

IV. Provider business mailing address

2029 35N HEMPSTEAD CR
OZAN AR
71855
US

V. Phone/Fax

Practice location:
  • Phone: 870-703-5525
  • Fax:
Mailing address:
  • Phone: 870-200-3543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number943134299
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: