Healthcare Provider Details

I. General information

NPI: 1376968081
Provider Name (Legal Business Name): LAUREN E COOPER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN E GOFF

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 S 1100 E STE 303
SALT LAKE CITY UT
84102-1891
US

IV. Provider business mailing address

PO BOX 800022
KANSAS CITY MO
64180-0022
US

V. Phone/Fax

Practice location:
  • Phone: 801-533-2002
  • Fax: 801-323-9546
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9749510-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: