MEDICARE: MRS. LESLIE JO COOPER ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	2345P	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174594865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLIE JO COOPER ARNP

Provider Business Mailing Address
First Line	:	PO BOX 128
Second Line	:	302 WEST MAIN ST
City	:	WARSAW
State	:	KY
Zip	:	41095
Country	:	US
Telephone Number	:	859-567-2754
Fax Number	:	859-567-5108

Provider Business Practice Location Address
First Line	:	302 WEST MAIN ST
Second Line	:
City	:	WARSAW
State	:	KY
Zip	:	41095
Country	:	US
Telephone Number	:	859-567-2754
Fax Number	:	859-567-5108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/08/2007

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