MEDICARE: DARRAH COOPER

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	363LF0000X	Family Nurse Practitioner	903310	MS

General Provider Information

NPI Number	:	1376169904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRAH COOPER

Provider Business Mailing Address
First Line	:	2107 WESTON DR
Second Line	:
City	:	CORINTH
State	:	MS
Zip	:	38834-2412
Country	:	US
Telephone Number	:	662-416-9460
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 N HARPER RD
Second Line	:
City	:	CORINTH
State	:	MS
Zip	:	38834-5271
Country	:	US
Telephone Number	:	662-286-1901
Fax Number	:

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

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	08/25/2020

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Directions to “ DARRAH COOPER ” Practice Location

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