Healthcare Provider Details

I. General information

NPI: 1144589292
Provider Name (Legal Business Name): GENA LYNN COOPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S LIMESTONE
LEXINGTON KY
40536-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML 2008
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5901
  • Fax: 859-323-3040
Mailing address:
  • Phone: 513-636-4244
  • Fax: 513-636-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number35.150707
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number51360
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number59357
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number51360
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: