Healthcare Provider Details

I. General information

NPI: 1548581218
Provider Name (Legal Business Name): JESSICA ROSE COOPER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6438 WILMINGTON PIKE STE 300
CENTERVILLE OH
45459-7021
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-848-4850
  • Fax: 937-848-4858
Mailing address:
  • Phone: 937-762-1310
  • Fax: 375-228-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License NumberAPRN.CNP.10960
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN.CNP.10960
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: