Healthcare Provider Details

I. General information

NPI: 1124910757
Provider Name (Legal Business Name): SARAH MOSES COOPER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 WALNUT GROVE CHURCH RD
DAYTON TN
37321-7925
US

IV. Provider business mailing address

203 COUNTY ROAD 142
RICEVILLE TN
37370-5529
US

V. Phone/Fax

Practice location:
  • Phone: 423-775-5512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number39248
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: