Healthcare Provider Details

I. General information

NPI: 1578117149
Provider Name (Legal Business Name): JORDYN COOPER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 BAPTISTE DR STE A
PAOLA KS
66071-1888
US

IV. Provider business mailing address

1401 BAPTISTE DR STE A
PAOLA KS
66071-1888
US

V. Phone/Fax

Practice location:
  • Phone: 913-294-2305
  • Fax: 913-294-2305
Mailing address:
  • Phone: 913-294-2305
  • Fax: 913-294-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number2015018000
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79001
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: