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General NPI Number Information
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NPI Number | 1720228950
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Entity Type | Individual
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Provider Name | JENNIFER ANNE COOPER-LEWIS D.O.
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Gender | Female
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 1235 E CHEROKEE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2203
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Country | US
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Telephone | 417-820-2115
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Fax | 417-820-5344
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Provider Business Mailing Address
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Address Line | PO BOX 504274
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City | SAINT LOUIS
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State | MO
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Zip | 63150-4274
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Country | US
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Telephone | 417-829-4620
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Fax | 417-829-4316
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 068394
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2015015950
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License Number State | MO
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