Healthcare Provider Details

I. General information

NPI: 1144822644
Provider Name (Legal Business Name): VALERIE RENEE COOPER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 NE KENNETH FORD DR
ROSEBURG OR
97470-1042
US

IV. Provider business mailing address

1470 W TARRAGON DR
ROSEBURG OR
97471-7739
US

V. Phone/Fax

Practice location:
  • Phone: 541-580-1148
  • Fax:
Mailing address:
  • Phone: 541-580-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number202009566NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: