MEDICARE: JENNIFER NICOLE COOPER PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN-NP243102	GA
2	163W00000X	Registered Nurse	RN243102	GA

General Provider Information

NPI Number	:	1750048849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NICOLE COOPER PMHNP-BC

Provider Business Mailing Address
First Line	:	1001 JOHNSON FERRY RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 CHANTILLY DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-3267
Country	:	US
Telephone Number	:	404-785-7878
Fax Number	:

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

Provider Enumeration Date	:	11/23/2021
Last Update Date	:	01/14/2026

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