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General NPI Number Information
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NPI Number | 1447703764
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Entity Type | Individual
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Provider Name | MIRANDA COOPER NP
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Gender | Female
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 1113 OGLETHORPE
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City | HINESVILLE
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State | GA
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Zip | 31313
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Country | US
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Telephone | 912-876-5085
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Fax |
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Provider Business Mailing Address
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Address Line | 150 SCRANTON CONNECTOR
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City | BRUNSWICK
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State | GA
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Zip | 31525-0540
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Country | US
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Telephone | 912-876-5085
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN162862
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License Number State | GA
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