Healthcare Provider Details

I. General information

NPI: 1033666466
Provider Name (Legal Business Name): KENNEATHER COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 ST CHARLES STREET SUITE 2500
NEW ORLEANS LA
70170-4405
US

IV. Provider business mailing address

500 FAIRWAY DR. SUITE 102
DEERFIELD BEACH FL
70130-4405
US

V. Phone/Fax

Practice location:
  • Phone: 504-906-5134
  • Fax:
Mailing address:
  • Phone: 888-880-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: