Healthcare Provider Details

I. General information

NPI: 1881546513
Provider Name (Legal Business Name): ANDREW COOP CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 COPPER LAKES BLVD
GROVER MO
63040-1920
US

IV. Provider business mailing address

340 COPPER LAKES BLVD
GROVER MO
63040-1920
US

V. Phone/Fax

Practice location:
  • Phone: 217-737-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2019020951
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209036138
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: