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General NPI Number Information
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NPI Number | 1104781079
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Entity Type | Individual
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Provider Name | ANNA GAYLE COOPER FNP
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Gender | Female
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 101 FARM VIEW DR
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City | OXFORD
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State | MS
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Zip | 38655-7728
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Country | US
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Telephone | 662-513-4399
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Fax |
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Provider Business Mailing Address
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Address Line | 4131 HIGHWAY 349 S
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City | POTTS CAMP
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State | MS
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Zip | 38659-9664
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Country | US
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Telephone | 662-316-0947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 908050
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License Number State | MS
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