Healthcare Provider Details

I. General information

NPI: 1841105186
Provider Name (Legal Business Name): GRACE COOPER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CHERRY AVE
MC KENZIE TN
38201-1769
US

IV. Provider business mailing address

305 CONSTELLATION CIR APT 305
JACKSON TN
38305-6671
US

V. Phone/Fax

Practice location:
  • Phone: 731-352-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3324
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: