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NPI Code Detail

MEDICARE: KRYSTA MYCHAL COOPER APRN, CNP

MEDICARE: KRYSTA MYCHAL COOPER APRN, CNP
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
1207Q00000XFamily Medicine PhysicianLE-00024808OH
2363LF0000XFamily Nurse PractitionerAPRN.CNP.023461OH

Other Identifiers

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

General Provider Information

NPI Number : 1346728730
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTA MYCHAL COOPER APRN, CNP
Provider Business Mailing Address
First Line : 4790 COTTONVILLE RD
Second Line :
City : JAMESTOWN
State : OH
Zip : 45335-1518
Country : US
Telephone Number : 937-675-2870
Fax Number : 937-675-2873
Provider Business Practice Location Address
First Line : 4790 COTTONVILLE RD
Second Line :
City : JAMESTOWN
State : OH
Zip : 45335-1518
Country : US
Telephone Number : 937-675-2870
Fax Number : 937-675-2873
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2018
Last Update Date : 12/02/2020

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