Healthcare Provider Details

I. General information

NPI: 1881947893
Provider Name (Legal Business Name): KOREN F COOPER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KOREN V FLEMING

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16011 KAIROS RD SUITE 300
SOUTH CHESTERFIELD VA
23834
US

IV. Provider business mailing address

107 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4521
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-5223
  • Fax: 804-520-5746
Mailing address:
  • Phone: 804-330-4901
  • Fax: 804-330-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-03871
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110005485
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: