Healthcare Provider Details

I. General information

NPI: 1609653831
Provider Name (Legal Business Name): JENNIFER LYNN COOPER AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 E 57TH ST STE B
SIOUX FALLS SD
57108-8627
US

IV. Provider business mailing address

309 S WIPF ST
FREEMAN SD
57029-2011
US

V. Phone/Fax

Practice location:
  • Phone: 605-305-4080
  • Fax:
Mailing address:
  • Phone: 440-220-2765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200608
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number200608
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number200608
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: