Healthcare Provider Details

I. General information

NPI: 1821440702
Provider Name (Legal Business Name): KOURTNEY L COOPER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 COURT ST
UTICA NY
13502-4236
US

IV. Provider business mailing address

502 COURT ST
UTICA NY
13502-4236
US

V. Phone/Fax

Practice location:
  • Phone: 315-507-5800
  • Fax: 315-507-5802
Mailing address:
  • Phone: 315-507-5800
  • Fax: 315-507-5802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number565099
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: