Healthcare Provider Details

I. General information

NPI: 1730559154
Provider Name (Legal Business Name): JESSICA MEREDITH COOPER N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 STILES RD STE 210
SALEM NH
03079
US

IV. Provider business mailing address

23 STILES RD STE 210
SALEM NH
03079-2853
US

V. Phone/Fax

Practice location:
  • Phone: 603-458-6579
  • Fax:
Mailing address:
  • Phone: 603-458-6579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number15-1504
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number122
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: