Healthcare Provider Details

I. General information

NPI: 1104781079
Provider Name (Legal Business Name): ANNA GAYLE COOPER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FARM VIEW DR
OXFORD MS
38655-7728
US

IV. Provider business mailing address

4131 HIGHWAY 349 S
POTTS CAMP MS
38659-9664
US

V. Phone/Fax

Practice location:
  • Phone: 662-513-4399
  • Fax:
Mailing address:
  • Phone: 662-316-0947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number908050
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: