Healthcare Provider Details

I. General information

NPI: 1861106973
Provider Name (Legal Business Name): COOPER HEALTH MOBILE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14632 BROTHERLY LANE
CARLOTTE NC
28278
US

IV. Provider business mailing address

14632 BROTHERLY LANE
CHAROTTE NC
28278
US

V. Phone/Fax

Practice location:
  • Phone: 704-770-6435
  • Fax:
Mailing address:
  • Phone: 704-770-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. RHONDA COOPER BRIDGET
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP-BC
Phone: 704-770-6435