Healthcare Provider Details

I. General information

NPI: 1285647313
Provider Name (Legal Business Name): HEATHER MICHELLE COOPER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MICHELLE JOHNSON

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E. THIRD STREET
CHATTANOOGA TN
37403
US

IV. Provider business mailing address

PO BOX 2930
INDIANAPOLIS IN
46206-2930
US

V. Phone/Fax

Practice location:
  • Phone: 423-602-8400
  • Fax: 423-602-8401
Mailing address:
  • Phone: 844-468-9496
  • Fax: 855-630-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN129057
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN12282
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: