Healthcare Provider Details

I. General information

NPI: 1649128497
Provider Name (Legal Business Name): JEAN COOLE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 W PEORIA AVE
PHOENIX AZ
85029-5226
US

IV. Provider business mailing address

2875 W RAY RD STE 6-317
CHANDLER AZ
85224-3524
US

V. Phone/Fax

Practice location:
  • Phone: 833-568-0473
  • Fax:
Mailing address:
  • Phone: 480-818-4787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN170133
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: