MEDICARE: MS. KAYLA LYN COOPER LPN

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	164W00000X	Licensed Practical Nurse	LPN.190727	OH

General Provider Information

NPI Number	:	1386449528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAYLA LYN COOPER LPN

Provider Business Mailing Address
First Line	:	287 E LEFFEL LN
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-4745
Country	:	US
Telephone Number	:	937-688-1844
Fax Number	:

Provider Business Practice Location Address
First Line	:	287 E LEFFEL LN
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-4745
Country	:	US
Telephone Number	:	937-688-1844
Fax Number	:

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

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	02/13/2025

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