Healthcare Provider Details

I. General information

NPI: 1902854706
Provider Name (Legal Business Name): JANET R COOPER MSN, RN, PHD(C)
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 N WEST ST
JACKSON MS
39202-2018
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-354-6655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR617075
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: