Healthcare Provider Details

I. General information

NPI: 1023574605
Provider Name (Legal Business Name): LEONARD JOSEPH COOLEY DNP, APNP, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6129 NASBY DR
GALLOWAY OH
43119-8291
US

IV. Provider business mailing address

PO BOX 586
GALLOWAY OH
43119-0586
US

V. Phone/Fax

Practice location:
  • Phone: 317-559-0950
  • Fax:
Mailing address:
  • Phone: 608-723-8177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0030649
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: