Healthcare Provider Details

I. General information

NPI: 1851398747
Provider Name (Legal Business Name): KAREN ANN COOPER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 DUTCH FORK RD
CHAPIN SC
29036-7576
US

IV. Provider business mailing address

PO BOX 1869
FLETCHER NC
28732-1869
US

V. Phone/Fax

Practice location:
  • Phone: 910-742-9243
  • Fax: 888-746-1787
Mailing address:
  • Phone: 828-687-5616
  • Fax: 828-650-8076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3919
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201220
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: