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General NPI Number Information
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NPI Number | 1528526704
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Entity Type | Individual
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Provider Name | DEANGELO CARTEZ COOPER
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Gender | Male
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 03/07/2019
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Provider Practice Location Address
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Address Line | 4371 NARROW LANE RD STE 205
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City | MONTGOMERY
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State | AL
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Zip | 36116-2975
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Country | US
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Telephone | 334-323-3307
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Fax |
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Provider Business Mailing Address
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Address Line | 2008 LONGLEAF DR APT G
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City | VESTAVIA HILLS
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State | AL
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Zip | 35216-6210
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Country | US
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Telephone | 205-568-5470
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2018071930
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License Number State | AL
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