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General NPI Number Information
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NPI Number | 1629661210
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Entity Type | Individual
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Provider Name | HEIDI JO COOPER PNP
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Gender | Female
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 2310 N MOLTER RD STE 206
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-8621
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Country | US
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Telephone | 509-289-4969
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Fax | 509-289-4968
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Provider Business Mailing Address
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Address Line | 2310 N MOLTER RD STE 206
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-8621
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Country | US
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Telephone | 509-289-4969
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Fax | 509-289-4968
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP61677729
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | NP74551
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License Number State | ID
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