Individual
JACQUELINE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
212 LOT1 COUNTY RD 331, HOUSTON, MS 38851
(662) 542-9440
Mailing address
303 COUNTY ROAD 331, HOUSTON, MS 38851-7006
(662) 542-9440
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
895548
MS
163WH0200X
Home Health Registered Nurse
895548
MS
374U00000X
Home Health Aide
895548
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
863785168
MEDICARE
MS
05
—
863785168
—
MS
Enumeration date
07/11/2022
Last updated
07/11/2022
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