MEDICARE: KENYA K 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	374U00000X	Home Health Aide	83-1760934	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83-1760934	OTHER	MI	HOME HEALTH CARE

General Provider Information

NPI Number	:	1922580018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYA K COOPER

Provider Business Mailing Address
First Line	:	2746 WOLCOTT ST
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48504-3357
Country	:	US
Telephone Number	:	810-525-5222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2746 WOLCOTT ST
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48504-3357
Country	:	US
Telephone Number	:	810-525-5222
Fax Number	:

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

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	09/05/2018

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Directions to “ KENYA K COOPER ” Practice Location

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