=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659135994
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KINSLEY SHARLA COOPER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2024
-----------------------------------------------------
Last Update Date | 02/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 48642 871ST RD
-----------------------------------------------------
City | ONEILL
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68763-4679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-992-4417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 48642 871ST RD
-----------------------------------------------------
City | ONEILL
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68763-4679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-992-4417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------