Healthcare Provider Details

I. General information

NPI: 1619479888
Provider Name (Legal Business Name): MRS. ALEXANDRA COOPER BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 LOOP RD
WINNSBORO LA
71295-3344
US

IV. Provider business mailing address

2106 LOOP RD
WINNSBORO LA
71295-3344
US

V. Phone/Fax

Practice location:
  • Phone: 318-412-5265
  • Fax: 318-435-3842
Mailing address:
  • Phone: 318-412-5265
  • Fax: 318-435-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number123456
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number123456
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: