Individual
MR. JACKSON COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
971 LAKELAND DR STE 1052, JACKSON, MS 39216-4609
(601) 981-9503
Mailing address
971 LAKELAND DR STE 1052, JACKSON, MS 39216-4609
(601) 981-9503
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
906765
MS
Other
Enumeration date
07/02/2024
Last updated
07/02/2024
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