Healthcare Provider Details

I. General information

NPI: 1376163220
Provider Name (Legal Business Name): LAURETTA KOOPER DNP, APRN, NP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18023 OAKFIELD GLEN LN
CYPRESS TX
77433-2186
US

IV. Provider business mailing address

7200 CAMBRIDGE ST
HOUSTON TX
77030-4202
US

V. Phone/Fax

Practice location:
  • Phone: 678-656-5605
  • Fax:
Mailing address:
  • Phone: 713-798-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP143239
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1054685
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberAP143239
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number777077
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: