MEDICARE: MAVIS TAYLOR 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	207Q00000X	Family Medicine Physician	339883	AZ

General Provider Information

NPI Number	:	1942132949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAVIS TAYLOR COOPER

Provider Business Mailing Address
First Line	:	6220 RW FIELDS RD
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86303-6128
Country	:	US
Telephone Number	:	970-819-4201
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 WILLOW CREEK RD
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1108
Country	:	US
Telephone Number	:	928-955-4074
Fax Number	:

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ MAVIS TAYLOR COOPER ” Practice Location

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