Healthcare Provider Details

I. General information

NPI: 1891853354
Provider Name (Legal Business Name): PAUL BRANDON COOPER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 MEMORIAL CIR
OKLAHOMA CITY OK
73142
US

IV. Provider business mailing address

4505 MEMORIAL CIR
OKLAHOMA CITY OK
73142-5004
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-7099
  • Fax: 405-755-9237
Mailing address:
  • Phone: 405-749-7099
  • Fax: 405-755-9237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number100353
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number100353
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: