Healthcare Provider Details

I. General information

NPI: 1689724841
Provider Name (Legal Business Name): KATHLEEN A COOPER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 TALCOLTVILLE RD SUITE 1
VERNON CT
06066-5261
US

IV. Provider business mailing address

LAHEY CLINIC 41 MALL RD.
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 860-870-6370
  • Fax:
Mailing address:
  • Phone: 781-744-8000
  • Fax: 781-744-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2079
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5389
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: