Healthcare Provider Details

I. General information

NPI: 1174302830
Provider Name (Legal Business Name): CHERYL COOPER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 2ND AVE N
COLUMBUS MS
39701-4513
US

IV. Provider business mailing address

48 MEDICAL PARK DR E STE 453
BIRMINGHAM AL
35235-3472
US

V. Phone/Fax

Practice location:
  • Phone: 661-434-4210
  • Fax: 601-657-1044
Mailing address:
  • Phone: 205-208-9312
  • Fax: 205-848-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number906185
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: