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General NPI Number Information
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NPI Number | 1427335348
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Entity Type | Individual
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Provider Name | SCOTT ALLEN COOPER PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/06/2011
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1420 12TH AVE NW
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City | ARDMORE
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State | OK
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Zip | 73401
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Country | US
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Telephone | 580-798-4122
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Fax | 580-405-2048
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Provider Business Mailing Address
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Address Line | 1420 12TH AVE NW
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City | ARDMORE
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State | OK
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Zip | 73401
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Country | US
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Telephone | 580-798-4122
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Fax | 580-405-2048
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 60779055
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 55258
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MED-PAC-LIC-60682
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License Number State | MT
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 126935
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License Number State | AK
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Taxonomy #5
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-1286
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License Number State | AR
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Taxonomy #6
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2044
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License Number State | OK
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