Healthcare Provider Details

I. General information

NPI: 1083150601
Provider Name (Legal Business Name): HAROLD COOPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATT COOPER NP

II. Dates (important events)

Enumeration Date: 01/07/2017
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOUSE AVE STE 201
CHEYENNE WY
82001-3177
US

IV. Provider business mailing address

PO BOX 20970
CHEYENNE WY
82003-7020
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-7757
  • Fax: 307-638-8359
Mailing address:
  • Phone: 307-638-7757
  • Fax: 307-638-8359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-135062
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number58633
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: