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General NPI Number Information
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NPI Number | 1306124854
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Entity Type | Individual
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Provider Name | PHILLIP ANDREW COOPER CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/02/2011
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 300 WERNER STREET
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City | HOT SPRINGS
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State | AR
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Zip | 71913-6921
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Country | US
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Telephone | 501-622-1875
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Fax | 501-622-1925
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Provider Business Mailing Address
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Address Line | 3810 CENTRAL AVENUE SUITE H
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City | HOT SPRINGS
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State | AR
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Zip | 71913-6921
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Country | US
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Telephone | 501-525-5840
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Fax | 501-525-1762
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RNLICENSE#R79207
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA#C02873
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License Number State | AR
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