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Individual

CHARLES DERICK COOPER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
126 W MAIN ST, GUN BARREL CITY, TX 75156-5403
(903) 887-1092
Mailing address
4224 VZ COUNTY ROAD 2112, WILLS POINT, TX 75169-7786
(903) 594-8309

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1112062
TX
363LF0000X
Family Nurse Practitioner
1112062
TX

Other

Enumeration date
03/02/2023
Last updated
12/20/2023
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