Healthcare Provider Details

I. General information

NPI: 1831347863
Provider Name (Legal Business Name): RACHEL ANNE COOPER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N. STATE ST
JACKSON MS
39216
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-6064
  • Fax:
Mailing address:
  • Phone: 601-815-6064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000492
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA3712
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: