MEDICARE: TERESA MAY COOPER FNP-C

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	AP4965	AZ
2	363LF0000X	Family Nurse Practitioner	CNP-01562	NM
3	363LF0000X	Family Nurse Practitioner	AP112436	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8Y4019	OTHER	TX	BCBS PVN

General Provider Information

NPI Number	:	1609995612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA MAY COOPER FNP-C

Provider Business Mailing Address
First Line	:	1051 LIPAN APACHE RUN
Second Line	:
City	:	BLANCO
State	:	TX
Zip	:	78606-6210
Country	:	US
Telephone Number	:	512-422-6679
Fax Number	:

Provider Business Practice Location Address
First Line	:	5211 FM 2920 RD STE 101
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-3004
Country	:	US
Telephone Number	:	281-783-8162
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	11/08/2023

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Directions to “ TERESA MAY COOPER FNP-C” Practice Location

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