Healthcare Provider Details

I. General information

NPI: 1033193065
Provider Name (Legal Business Name): MELISSA E COOPER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 MCLAUGHLIN RD
PEYTON CO
80831-4716
US

IV. Provider business mailing address

1909 MEDICI LN
COLORADO SPRINGS CO
80921-4196
US

V. Phone/Fax

Practice location:
  • Phone: 719-495-9994
  • Fax:
Mailing address:
  • Phone: 662-328-9623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR718106
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0994208-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: