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General NPI Number Information
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NPI Number | 1790776722
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Entity Type | Individual
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Provider Name | JANE M COOPER N.P.
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Gender | Female
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 08/29/2017
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Provider Practice Location Address
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Address Line | 1189 TIBWIN ROAD
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City | MCCLELLANVILLE
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State | SC
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Zip | 29458-9405
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Country | US
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Telephone | 843-887-3274
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Fax | 843-887-3929
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Provider Business Mailing Address
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Address Line | P.O. BOX 608
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City | MCCLELLANVILLE
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State | SC
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Zip | 29458-0608
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Country | US
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Telephone | 843-887-3274
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Fax | 843-887-3929
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F3048
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License Number State | SC
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