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General NPI Number Information
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NPI Number | 1588438857
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Entity Type | Individual
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Provider Name | KATIE LYNN COOPER
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Gender | Female
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 222 GORDON ST
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City | BREMEN
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State | GA
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Zip | 30110-1519
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Country | US
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Telephone | 770-537-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 141 HARPER RD
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City | BREMEN
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State | GA
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Zip | 30110-3341
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Country | US
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Telephone |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN-NP302846
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN302846
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License Number State | GA
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