Healthcare Provider Details

I. General information

NPI: 1093786451
Provider Name (Legal Business Name): WILLIAM T COOPER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W TRUMAN RD SUITE 108
INDEPENDENCE MO
64050-3436
US

IV. Provider business mailing address

1515 W TRUMAN RD SUITE 108
INDEPENDENCE MO
64050-3436
US

V. Phone/Fax

Practice location:
  • Phone: 816-461-3131
  • Fax: 816-461-1662
Mailing address:
  • Phone: 816-461-3131
  • Fax: 816-461-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1318997
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: