=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104290600
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA L COOPER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2015
-----------------------------------------------------
Last Update Date | 11/16/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4320 WORNALL RD SUITE 710
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64111-5941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-932-2700
-----------------------------------------------------
Fax | 816-932-2705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 E. 104TH ST. MAILSTOP 400N
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64131-9712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-502-7117
-----------------------------------------------------
Fax | 816-932-9670
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 2013017571
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 2015043741
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------