Individual
JENNA JOE ROSE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2204 JEFFERSON DAVIS DR, OXFORD, MS 38655-5222
(662) 316-6133
Mailing address
2204 JEFFERSON DAVIS DR, OXFORD, MS 38655-5222
(662) 316-6133
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
PA00382
MS
Other
Enumeration date
07/26/2018
Last updated
07/26/2018
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