Healthcare Provider Details

I. General information

NPI: 1669413134
Provider Name (Legal Business Name): JANINE LYNN COOPER PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN STREET SUITE 1842
HOUSTON TX
77030-2761
US

IV. Provider business mailing address

P. O. BOX 4346 DEPT 205
HOUSTON TX
77210-4346
US

V. Phone/Fax

Practice location:
  • Phone: 713-790-2089
  • Fax: 713-794-0576
Mailing address:
  • Phone: 713-790-5227
  • Fax: 713-790-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA04724
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: