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General NPI Number Information
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NPI Number | 1851676308
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Entity Type | Organization
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Legal Business Name | COOPER ADVANCED PRACTICE
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 07/09/2012
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Provider Practice Location Address
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Address Line | 18230 FM 1488 RD SUITE 328
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City | MAGNOLIA
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State | TX
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Zip | 77354-4528
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Country | US
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Telephone | 936-242-9809
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Fax | 832-460-2685
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Provider Business Mailing Address
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Address Line | 26702 STAGECOACH CROSSING DR
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City | MAGNOLIA
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State | TX
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Zip | 77355-2198
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Country | US
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Telephone | 936-242-9809
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Fax | 832-460-2685
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Authorized Official
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Title or Position | OWNER
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Name | TRENT COOPER
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Credential | NP
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Telephone | 936-242-9809
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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 | 666237
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License Number State | TX
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