MEDICARE: KATE COOPER CRNA

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	367500000X	Certified Registered Nurse Anesthetist	AP116171	TX
2	367500000X	Certified Registered Nurse Anesthetist	688643	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	PENDING	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	87957U	OTHER	TX	BLUE CROSS PROVIDER ID

General Provider Information

NPI Number	:	1972703759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE COOPER CRNA

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PKWY
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-4997
Fax Number	:

Provider Business Practice Location Address
First Line	:	4008 TENNYSON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2748
Country	:	US
Telephone Number	:	347-803-3246
Fax Number	:

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

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	11/11/2021

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Directions to “ KATE COOPER CRNA” Practice Location

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