Healthcare Provider Details

I. General information

NPI: 1255900106
Provider Name (Legal Business Name): GEORGEANN COOPER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 FOREST AVE
MAYSVILLE KY
41056-1411
US

IV. Provider business mailing address

4897 RINGOS MILLS RD
HILLSBORO KY
41049-7582
US

V. Phone/Fax

Practice location:
  • Phone: 606-564-4016
  • Fax:
Mailing address:
  • Phone: 606-495-1094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3016036
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: