Healthcare Provider Details

I. General information

NPI: 1265296370
Provider Name (Legal Business Name): KRISTA COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 HEDGEWOOD DR
GALLIPOLIS OH
45631-1114
US

IV. Provider business mailing address

416 HEDGEWOOD DR
GALLIPOLIS OH
45631-1114
US

V. Phone/Fax

Practice location:
  • Phone: 740-853-1065
  • Fax:
Mailing address:
  • Phone: 740-853-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: